{ "resourceType": "Bundle", "type": "transaction", "entry": [ { "fullUrl": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "resource": { "resourceType": "Patient", "id": "328cb6c4-843e-26c6-7d6e-a374aba9eb60", "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: -7452248679687495754 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": "Genoveva361 Predovic534" }, { "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex", "valueCode": "M" }, { "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace", "valueAddress": { "city": "Cambridge", "state": "Massachusetts", "country": "US" } }, { "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years", "valueDecimal": 0.8938683781966251 }, { "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years", "valueDecimal": 47.10613162180338 } ], "identifier": [ { "system": "https://github.com/synthetichealth/synthea", "value": "328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, { "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": "328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, { "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": "999-66-4811" }, { "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": "S99995835" }, { "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": "X20495343X" } ], "name": [ { "use": "official", "family": "Ferry570", "given": [ "Aaron697", "Bruno518" ], "prefix": [ "Mr." ] } ], "telecom": [ { "system": "phone", "value": "555-703-9253", "use": "home" } ], "gender": "male", "birthDate": "1974-08-13", "address": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/geolocation", "extension": [ { "url": "latitude", "valueDecimal": 42.437072672139564 }, { "url": "longitude", "valueDecimal": -71.48513678926024 } ] } ], "line": [ "942 Stroman Way" ], "city": "Acton", "state": "MA", "postalCode": "00000", "country": "US" } ], "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M", "display": "Married" } ], "text": "Married" }, "multipleBirthBoolean": false, "communication": [ { "language": { "coding": [ { "system": "urn:ietf:bcp:47", "code": "en-US", "display": "English (United States)" } ], "text": "English (United States)" } } ] }, "request": { "method": "POST", "url": "Patient" } }, { "fullUrl": "urn:uuid:bd9f9186-8c3c-3bfc-737d-f82fed89d1a4", "resource": { "resourceType": "Encounter", "id": "bd9f9186-8c3c-3bfc-737d-f82fed89d1a4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "bd9f9186-8c3c-3bfc-737d-f82fed89d1a4" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1992-10-06T00:11:11-04:00", "end": "1992-10-06T01:03:05-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "1992-10-06T00:11:11-04:00", "end": "1992-10-06T01:03:05-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:44dbcc7b-0022-a40d-8872-92e314ee1e48", "resource": { "resourceType": "Condition", "id": "44dbcc7b-0022-a40d-8872-92e314ee1e48", "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": "105531004", "display": "Housing unsatisfactory (finding)" } ], "text": "Housing unsatisfactory (finding)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:bd9f9186-8c3c-3bfc-737d-f82fed89d1a4" }, "onsetDateTime": "1992-10-06T01:03:05-04:00", "recordedDate": "1992-10-06T01:03:05-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:e4c71704-4b98-8eeb-35d2-2e86a49a5c0e", "resource": { "resourceType": "Condition", "id": "e4c71704-4b98-8eeb-35d2-2e86a49a5c0e", "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": "224299000", "display": "Received higher education (finding)" } ], "text": "Received higher education (finding)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:bd9f9186-8c3c-3bfc-737d-f82fed89d1a4" }, "onsetDateTime": "1992-10-06T01:03:05-04:00", "recordedDate": "1992-10-06T01:03:05-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:08f1b35f-00c2-c60d-e34a-14b1d0e7f9c2", "resource": { "resourceType": "DiagnosticReport", "id": "08f1b35f-00c2-c60d-e34a-14b1d0e7f9c2", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:bd9f9186-8c3c-3bfc-737d-f82fed89d1a4" }, "effectiveDateTime": "1992-10-06T00:11:11-04:00", "issued": "1992-10-06T00:11:11.671-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:c3d254b5-bd06-857f-e970-038880111c00", "resource": { "resourceType": "DocumentReference", "id": "c3d254b5-bd06-857f-e970-038880111c00", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:08f1b35f-00c2-c60d-e34a-14b1d0e7f9c2" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "1992-10-06T00:11:11.671-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:bd9f9186-8c3c-3bfc-737d-f82fed89d1a4" } ], "period": { "start": "1992-10-06T00:11:11-04:00", "end": "1992-10-06T01:03:05-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:45d2e0af-b741-9a22-6e56-5079f00a82e5", "resource": { "resourceType": "Claim", "id": "45d2e0af-b741-9a22-6e56-5079f00a82e5", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "1992-10-06T00:11:11-04:00", "end": "1992-10-06T01:03:05-04:00" }, "created": "1992-10-06T01:03:05-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:44dbcc7b-0022-a40d-8872-92e314ee1e48" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:e4c71704-4b98-8eeb-35d2-2e86a49a5c0e" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:bd9f9186-8c3c-3bfc-737d-f82fed89d1a4" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "105531004", "display": "Housing unsatisfactory (finding)" } ], "text": "Housing unsatisfactory (finding)" } }, { "sequence": 3, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "224299000", "display": "Received higher education (finding)" } ], "text": "Received higher education (finding)" } } ], "total": { "value": 1330.83, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:437a10c8-8e4b-070e-ee3a-2b641e56426b", "resource": { "resourceType": "ExplanationOfBenefit", "id": "437a10c8-8e4b-070e-ee3a-2b641e56426b", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "45d2e0af-b741-9a22-6e56-5079f00a82e5" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "1992-10-06T01:03:05-04:00", "end": "1993-10-06T01:03:05-04:00" }, "created": "1992-10-06T01:03:05-04:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:45d2e0af-b741-9a22-6e56-5079f00a82e5" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:44dbcc7b-0022-a40d-8872-92e314ee1e48" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:e4c71704-4b98-8eeb-35d2-2e86a49a5c0e" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "1992-10-06T00:11:11-04:00", "end": "1992-10-06T01:03:05-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:bd9f9186-8c3c-3bfc-737d-f82fed89d1a4" } ] }, { "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": "105531004", "display": "Housing unsatisfactory (finding)" } ], "text": "Housing unsatisfactory (finding)" }, "servicedPeriod": { "start": "1992-10-06T00:11:11-04:00", "end": "1992-10-06T01:03:05-04:00" }, "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": "224299000", "display": "Received higher education (finding)" } ], "text": "Received higher education (finding)" }, "servicedPeriod": { "start": "1992-10-06T00:11:11-04:00", "end": "1992-10-06T01:03:05-04:00" }, "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": 1330.83, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:1b2a1eef-a1de-e674-87e8-93b4a0e3fdf2", "resource": { "resourceType": "Encounter", "id": "1b2a1eef-a1de-e674-87e8-93b4a0e3fdf2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "1b2a1eef-a1de-e674-87e8-93b4a0e3fdf2" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2002-10-22T00:11:11-04:00", "end": "2002-10-22T00:42:18-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2002-10-22T00:11:11-04:00", "end": "2002-10-22T00:42:18-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:325356ca-5873-2f06-16a4-d87a802ee632", "resource": { "resourceType": "Condition", "id": "325356ca-5873-2f06-16a4-d87a802ee632", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1b2a1eef-a1de-e674-87e8-93b4a0e3fdf2" }, "onsetDateTime": "2002-10-22T00:42:18-04:00", "abatementDateTime": "2005-10-25T00:55:44-04:00", "recordedDate": "2002-10-22T00:42:18-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:6912c771-3902-d55f-3937-fb27135b36b2", "resource": { "resourceType": "DiagnosticReport", "id": "6912c771-3902-d55f-3937-fb27135b36b2", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1b2a1eef-a1de-e674-87e8-93b4a0e3fdf2" }, "effectiveDateTime": "2002-10-22T00:11:11-04:00", "issued": "2002-10-22T00:11:11.671-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:861688c2-43ce-80b5-4921-1f43696c2f88", "resource": { "resourceType": "DocumentReference", "id": "861688c2-43ce-80b5-4921-1f43696c2f88", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:6912c771-3902-d55f-3937-fb27135b36b2" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2002-10-22T00:11:11.671-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:1b2a1eef-a1de-e674-87e8-93b4a0e3fdf2" } ], "period": { "start": "2002-10-22T00:11:11-04:00", "end": "2002-10-22T00:42:18-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:603589fb-3b2e-1cf5-1157-69c72235d5dd", "resource": { "resourceType": "Claim", "id": "603589fb-3b2e-1cf5-1157-69c72235d5dd", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2002-10-22T00:11:11-04:00", "end": "2002-10-22T00:42:18-04:00" }, "created": "2002-10-22T00:42:18-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:325356ca-5873-2f06-16a4-d87a802ee632" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:1b2a1eef-a1de-e674-87e8-93b4a0e3fdf2" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" } } ], "total": { "value": 778.78, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:5fe3f4ca-7e30-2cb5-1b3e-11999850332c", "resource": { "resourceType": "ExplanationOfBenefit", "id": "5fe3f4ca-7e30-2cb5-1b3e-11999850332c", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "603589fb-3b2e-1cf5-1157-69c72235d5dd" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2002-10-22T00:42:18-04:00", "end": "2003-10-22T00:42:18-04:00" }, "created": "2002-10-22T00:42:18-04:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:603589fb-3b2e-1cf5-1157-69c72235d5dd" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:325356ca-5873-2f06-16a4-d87a802ee632" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2002-10-22T00:11:11-04:00", "end": "2002-10-22T00:42:18-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:1b2a1eef-a1de-e674-87e8-93b4a0e3fdf2" } ] }, { "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": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "servicedPeriod": { "start": "2002-10-22T00:11:11-04:00", "end": "2002-10-22T00:42:18-04:00" }, "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": 778.78, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8", "resource": { "resourceType": "Encounter", "id": "e0e6ef1c-f0fc-3475-1a9d-e59576a375f8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "resource": { "resourceType": "Condition", "id": "cd916a36-56e3-7c66-5c6b-cf805632c01d", "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": "59621000", "display": "Essential hypertension (disorder)" } ], "text": "Essential hypertension (disorder)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "onsetDateTime": "2008-10-28T00:11:11-04:00", "recordedDate": "2008-10-28T00:11:11-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:34d5f11b-1528-49a4-5281-8a30bafcd57d", "resource": { "resourceType": "Condition", "id": "34d5f11b-1528-49a4-5281-8a30bafcd57d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "15777000", "display": "Prediabetes" } ], "text": "Prediabetes" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "onsetDateTime": "2008-10-28T00:11:11-04:00", "recordedDate": "2008-10-28T00:11:11-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:13f5896e-1d14-d8f0-037e-4a29c6e0ca14", "resource": { "resourceType": "Condition", "id": "13f5896e-1d14-d8f0-037e-4a29c6e0ca14", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "271737000", "display": "Anemia (disorder)" } ], "text": "Anemia (disorder)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "onsetDateTime": "2008-10-28T00:11:11-04:00", "recordedDate": "2008-10-28T00:11:11-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:6eba9c55-dcec-1abd-d88d-cbae211d8f9b", "resource": { "resourceType": "Condition", "id": "6eba9c55-dcec-1abd-d88d-cbae211d8f9b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "onsetDateTime": "2008-10-28T01:06:42-04:00", "abatementDateTime": "2009-11-02T23:58:39-05:00", "recordedDate": "2008-10-28T01:06:42-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:d8ce0c8d-f739-bc81-1180-127efafbb79f", "resource": { "resourceType": "Device", "id": "d8ce0c8d-f739-bc81-1180-127efafbb79f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ] }, "udiCarrier": [ { "deviceIdentifier": "71433311760393", "carrierHRF": "(01)71433311760393(11)081007(17)331022(10)83897624920801452(21)6608393427292" } ], "status": "active", "distinctIdentifier": "71433311760393", "manufactureDate": "2008-10-07T00:11:11-04:00", "expirationDate": "2033-10-22T00:11:11-04:00", "lotNumber": "83897624920801452", "serialNumber": "6608393427292", "deviceName": [ { "name": "Blood glucose meter (physical object)", "type": "user-friendly-name" } ], "type": { "coding": [ { "system": "http://snomed.info/sct", "code": "337414009", "display": "Blood glucose meter (physical object)" } ], "text": "Blood glucose meter (physical object)" }, "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" } }, "request": { "method": "POST", "url": "Device" } }, { "fullUrl": "urn:uuid:d2c2660a-e08c-e278-0d05-ec2f5b165c8f", "resource": { "resourceType": "SupplyDelivery", "id": "d2c2660a-e08c-e278-0d05-ec2f5b165c8f", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2008-10-28T00:11:11-04:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:16b1392b-5371-79a3-5b25-8d8dc8a10a4c", "resource": { "resourceType": "MedicationRequest", "id": "16b1392b-5371-79a3-5b25-8d8dc8a10a4c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "authoredOn": "2008-10-28T00:11:11-04:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:b829272e-75e4-910b-844c-80494fb00d94", "resource": { "resourceType": "Claim", "id": "b829272e-75e4-910b-844c-80494fb00d94", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "created": "2008-10-28T01:06:42-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:16b1392b-5371-79a3-5b25-8d8dc8a10a4c" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ] } ], "total": { "value": 0.50, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:9eab5d6a-48b7-45a7-a0d1-226afc6d208e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "9eab5d6a-48b7-45a7-a0d1-226afc6d208e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "b829272e-75e4-910b-844c-80494fb00d94" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-10-28T01:06:42-04:00", "end": "2009-10-28T01:06:42-04:00" }, "created": "2008-10-28T01:06:42-04:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:b829272e-75e4-910b-844c-80494fb00d94" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.50, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:8ba06e78-1b70-51c6-eb62-53f5faa764ac", "resource": { "resourceType": "MedicationRequest", "id": "8ba06e78-1b70-51c6-eb62-53f5faa764ac", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "authoredOn": "2008-10-28T00:11:11-04:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:ec485030-fd22-d7d6-47a9-f3ea97a7bfe9", "resource": { "resourceType": "Claim", "id": "ec485030-fd22-d7d6-47a9-f3ea97a7bfe9", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "created": "2008-10-28T01:06:42-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:8ba06e78-1b70-51c6-eb62-53f5faa764ac" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:2937c67c-bf6e-be3e-df12-ad7ee533bef1", "resource": { "resourceType": "ExplanationOfBenefit", "id": "2937c67c-bf6e-be3e-df12-ad7ee533bef1", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "ec485030-fd22-d7d6-47a9-f3ea97a7bfe9" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-10-28T01:06:42-04:00", "end": "2009-10-28T01:06:42-04:00" }, "created": "2008-10-28T01:06:42-04:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:ec485030-fd22-d7d6-47a9-f3ea97a7bfe9" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:223da1d7-f016-486d-a1c3-0641b702c71a", "resource": { "resourceType": "MedicationRequest", "id": "223da1d7-f016-486d-a1c3-0641b702c71a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "authoredOn": "2008-10-28T00:11:11-04:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:22c191d5-b002-c284-c954-15582fd48035", "resource": { "resourceType": "Claim", "id": "22c191d5-b002-c284-c954-15582fd48035", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "created": "2008-10-28T01:06:42-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:223da1d7-f016-486d-a1c3-0641b702c71a" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ] } ], "total": { "value": 0.59, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:5187cc2e-5ec0-c2db-3efb-4d4141411cb6", "resource": { "resourceType": "ExplanationOfBenefit", "id": "5187cc2e-5ec0-c2db-3efb-4d4141411cb6", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "22c191d5-b002-c284-c954-15582fd48035" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-10-28T01:06:42-04:00", "end": "2009-10-28T01:06:42-04:00" }, "created": "2008-10-28T01:06:42-04:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:22c191d5-b002-c284-c954-15582fd48035" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.59, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:12966c6e-4c6e-080c-1284-5f96e9a7e0b9", "resource": { "resourceType": "MedicationRequest", "id": "12966c6e-4c6e-080c-1284-5f96e9a7e0b9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "authoredOn": "2008-10-28T00:11:11-04:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:43bd4551-6029-27af-bd4e-19ae46ea7d6c", "resource": { "resourceType": "Claim", "id": "43bd4551-6029-27af-bd4e-19ae46ea7d6c", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "created": "2008-10-28T01:06:42-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:12966c6e-4c6e-080c-1284-5f96e9a7e0b9" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e2c2459b-db7d-658c-277a-e5a25238c26d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e2c2459b-db7d-658c-277a-e5a25238c26d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "43bd4551-6029-27af-bd4e-19ae46ea7d6c" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-10-28T01:06:42-04:00", "end": "2009-10-28T01:06:42-04:00" }, "created": "2008-10-28T01:06:42-04:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:43bd4551-6029-27af-bd4e-19ae46ea7d6c" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:180b173f-71fb-1267-2aed-97594ce885e8", "resource": { "resourceType": "CareTeam", "id": "180b173f-71fb-1267-2aed-97594ce885e8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] }, "status": "active", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "period": { "start": "2008-10-28T00:11:11-04:00" }, "participant": [ { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "116154003", "display": "Patient" } ], "text": "Patient" } ], "member": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "223366009", "display": "Healthcare professional (occupation)" } ], "text": "Healthcare professional (occupation)" } ], "member": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "224891009", "display": "Healthcare services (qualifier value)" } ], "text": "Healthcare services (qualifier value)" } ], "member": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "59621000", "display": "Essential hypertension (disorder)" } ], "text": "Essential hypertension (disorder)" } ], "managingOrganization": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ] }, "request": { "method": "POST", "url": "CareTeam" } }, { "fullUrl": "urn:uuid:514aba1a-7da8-95c6-9f12-0133c96c320a", "resource": { "resourceType": "CarePlan", "id": "514aba1a-7da8-95c6-9f12-0133c96c320a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] }, "text": { "status": "generated", "div": "
Care Plan for Lifestyle education regarding hypertension.
Care plan is meant to treat Essential hypertension (disorder).
Activities:
" }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category", "code": "assess-plan" } ] }, { "coding": [ { "system": "http://snomed.info/sct", "code": "443402002", "display": "Lifestyle education regarding hypertension" } ], "text": "Lifestyle education regarding hypertension" } ], "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "period": { "start": "2008-10-28T00:11:11-04:00" }, "careTeam": [ { "reference": "urn:uuid:180b173f-71fb-1267-2aed-97594ce885e8" } ], "addresses": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d" } ], "activity": [ { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "386463000", "display": "Prescribed activity/exercise education" } ], "text": "Prescribed activity/exercise education" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d" } ], "status": "in-progress", "location": { "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "413473000", "display": "Counseling about alcohol consumption" } ], "text": "Counseling about alcohol consumption" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d" } ], "status": "in-progress", "location": { "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "1151000175103", "display": "Dietary approaches to stop hypertension diet" } ], "text": "Dietary approaches to stop hypertension diet" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d" } ], "status": "in-progress", "location": { "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "225323000", "display": "Smoking cessation education" } ], "text": "Smoking cessation education" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d" } ], "status": "in-progress", "location": { "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } } ] }, "request": { "method": "POST", "url": "CarePlan" } }, { "fullUrl": "urn:uuid:8c923c5e-5843-25ff-23a6-3f2d2faec208", "resource": { "resourceType": "CareTeam", "id": "8c923c5e-5843-25ff-23a6-3f2d2faec208", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] }, "status": "active", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "period": { "start": "2008-10-28T00:11:11-04:00" }, "participant": [ { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "116154003", "display": "Patient" } ], "text": "Patient" } ], "member": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "223366009", "display": "Healthcare professional (occupation)" } ], "text": "Healthcare professional (occupation)" } ], "member": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "224891009", "display": "Healthcare services (qualifier value)" } ], "text": "Healthcare services (qualifier value)" } ], "member": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "15777000", "display": "Prediabetes" } ], "text": "Prediabetes" } ], "managingOrganization": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ] }, "request": { "method": "POST", "url": "CareTeam" } }, { "fullUrl": "urn:uuid:f751f653-dc7c-cb32-bf47-b10f5c18316c", "resource": { "resourceType": "CarePlan", "id": "f751f653-dc7c-cb32-bf47-b10f5c18316c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] }, "text": { "status": "generated", "div": "
Care Plan for Diabetes self management plan.
Care plan is meant to treat Prediabetes.
Activities:
" }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category", "code": "assess-plan" } ] }, { "coding": [ { "system": "http://snomed.info/sct", "code": "698360004", "display": "Diabetes self management plan" } ], "text": "Diabetes self management plan" } ], "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "period": { "start": "2008-10-28T00:11:11-04:00" }, "careTeam": [ { "reference": "urn:uuid:8c923c5e-5843-25ff-23a6-3f2d2faec208" } ], "addresses": [ { "reference": "urn:uuid:34d5f11b-1528-49a4-5281-8a30bafcd57d" } ], "activity": [ { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160670007", "display": "Diabetic diet" } ], "text": "Diabetic diet" }, "reasonReference": [ { "reference": "urn:uuid:34d5f11b-1528-49a4-5281-8a30bafcd57d" } ], "status": "in-progress", "location": { "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "229065009", "display": "Exercise therapy" } ], "text": "Exercise therapy" }, "reasonReference": [ { "reference": "urn:uuid:34d5f11b-1528-49a4-5281-8a30bafcd57d" } ], "status": "in-progress", "location": { "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } } ] }, "request": { "method": "POST", "url": "CarePlan" } }, { "fullUrl": "urn:uuid:01e811cf-4968-3d8f-9800-668352b52b05", "resource": { "resourceType": "DiagnosticReport", "id": "01e811cf-4968-3d8f-9800-668352b52b05", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, "effectiveDateTime": "2008-10-28T00:11:11-04:00", "issued": "2008-10-28T00:11:11.671-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:993333cb-1b71-d8b5-009e-e87bde1778ff", "resource": { "resourceType": "DocumentReference", "id": "993333cb-1b71-d8b5-009e-e87bde1778ff", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:01e811cf-4968-3d8f-9800-668352b52b05" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2008-10-28T00:11:11.671-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMDgtMTAtMjgKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkFhcm9uNjk3CiBpcyBhIDM0IHllYXItb2xkIG5vbmhpc3BhbmljIHdoaXRlIG1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBwYXJ0LXRpbWUgZW1wbG95bWVudCAoZmluZGluZykuCgojIFNvY2lhbCBIaXN0b3J5ClBhdGllbnQgaXMgbWFycmllZC4gUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgogUGF0aWVudCBpZGVudGlmaWVzIGFzIGhldGVyb3NleHVhbC4KClBhdGllbnQgY29tZXMgZnJvbSBhIGhpZ2ggc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLgogUGF0aWVudCBpcyBhIGNvbGxlZ2UgZ3JhZHVhdGUuClBhdGllbnQgY3VycmVudGx5IGhhcyBVbml0ZWRIZWFsdGhjYXJlLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwpObyBBY3RpdmUgTWVkaWNhdGlvbnMuCgojIEFzc2Vzc21lbnQgYW5kIFBsYW4KUGF0aWVudCBpcyBwcmVzZW50aW5nIHdpdGggZXNzZW50aWFsIGh5cGVydGVuc2lvbiAoZGlzb3JkZXIpLCBwcmVkaWFiZXRlcywgYW5lbWlhIChkaXNvcmRlciksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKS4gCgojIyBQbGFuCgpUaGUgcGF0aWVudCB3YXMgcHJlc2NyaWJlZCB0aGUgZm9sbG93aW5nIG1lZGljYXRpb25zOgotIGh5ZHJvY2hsb3JvdGhpYXppZGUgMjUgbWcgb3JhbCB0YWJsZXQKLSBsaXNpbm9wcmlsIDEwIG1nIG9yYWwgdGFibGV0Ci0gaHlkcm9jaGxvcm90aGlhemlkZSAyNSBtZyBvcmFsIHRhYmxldAotIGxpc2lub3ByaWwgMTAgbWcgb3JhbCB0YWJsZXQKVGhlIHBhdGllbnQgd2FzIHBsYWNlZCBvbiBhIGNhcmVwbGFuOgotIGxpZmVzdHlsZSBlZHVjYXRpb24gcmVnYXJkaW5nIGh5cGVydGVuc2lvbgotIGRpYWJldGVzIHNlbGYgbWFuYWdlbWVudCBwbGFuCg==" }, "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:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ], "period": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:ddac8e64-7e52-847f-b769-7b612c55201b", "resource": { "resourceType": "Claim", "id": "ddac8e64-7e52-847f-b769-7b612c55201b", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "created": "2008-10-28T01:06:42-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:34d5f11b-1528-49a4-5281-8a30bafcd57d" } }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:13f5896e-1d14-d8f0-037e-4a29c6e0ca14" } }, { "sequence": 4, "diagnosisReference": { "reference": "urn:uuid:6eba9c55-dcec-1abd-d88d-cbae211d8f9b" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "59621000", "display": "Essential hypertension (disorder)" } ], "text": "Essential hypertension (disorder)" } }, { "sequence": 3, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "15777000", "display": "Prediabetes" } ], "text": "Prediabetes" } }, { "sequence": 4, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337414009", "display": "Blood glucose meter (physical object)" } ], "text": "Blood glucose meter (physical object)" }, "net": { "value": 63.64, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 6, "diagnosisSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "271737000", "display": "Anemia (disorder)" } ], "text": "Anemia (disorder)" } }, { "sequence": 7, "diagnosisSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" } } ], "total": { "value": 998.38, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:d2bc4ad0-0774-1ebc-8897-31d22d391f70", "resource": { "resourceType": "ExplanationOfBenefit", "id": "d2bc4ad0-0774-1ebc-8897-31d22d391f70", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "ddac8e64-7e52-847f-b769-7b612c55201b" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-10-28T01:06:42-04:00", "end": "2009-10-28T01:06:42-04:00" }, "created": "2008-10-28T01:06:42-04:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:ddac8e64-7e52-847f-b769-7b612c55201b" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:34d5f11b-1528-49a4-5281-8a30bafcd57d" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:13f5896e-1d14-d8f0-037e-4a29c6e0ca14" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 4, "diagnosisReference": { "reference": "urn:uuid:6eba9c55-dcec-1abd-d88d-cbae211d8f9b" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" } ] }, { "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": "59621000", "display": "Essential hypertension (disorder)" } ], "text": "Essential hypertension (disorder)" }, "servicedPeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "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": "15777000", "display": "Prediabetes" } ], "text": "Prediabetes" }, "servicedPeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 4, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337414009", "display": "Blood glucose meter (physical object)" } ], "text": "Blood glucose meter (physical object)" }, "servicedPeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 63.64, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 12.728000000000002, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 50.912000000000006, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 63.64, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 63.64, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "diagnosisSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "271737000", "display": "Anemia (disorder)" } ], "text": "Anemia (disorder)" }, "servicedPeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 7, "diagnosisSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "servicedPeriod": { "start": "2008-10-28T00:11:11-04:00", "end": "2008-10-28T01:06:42-04:00" }, "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": 998.38, "currency": "USD" } } ], "payment": { "amount": { "value": 56.352000000000004, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:95e46130-a4d2-f7c6-c007-6a9cfa7410b8", "resource": { "resourceType": "Encounter", "id": "95e46130-a4d2-f7c6-c007-6a9cfa7410b8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "95e46130-a4d2-f7c6-c007-6a9cfa7410b8" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "390906007", "display": "Follow-up encounter (procedure)" } ], "text": "Follow-up encounter (procedure)" } ], "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2008-11-26T23:11:11-05:00", "end": "2008-11-26T23:26:11-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } } ], "period": { "start": "2008-11-26T23:11:11-05:00", "end": "2008-11-26T23:26:11-05:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "59621000", "display": "Essential hypertension (disorder)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:12ffc493-eaaa-66f9-5851-ab34a39f252c", "resource": { "resourceType": "MedicationRequest", "id": "12ffc493-eaaa-66f9-5851-ab34a39f252c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:95e46130-a4d2-f7c6-c007-6a9cfa7410b8" }, "authoredOn": "2008-11-26T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:e145f926-6970-d1f9-8cf0-47f6a06c0555", "resource": { "resourceType": "Claim", "id": "e145f926-6970-d1f9-8cf0-47f6a06c0555", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-11-26T23:11:11-05:00", "end": "2008-11-26T23:26:11-05:00" }, "created": "2008-11-26T23:26:11-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:12ffc493-eaaa-66f9-5851-ab34a39f252c" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:95e46130-a4d2-f7c6-c007-6a9cfa7410b8" } ] } ], "total": { "value": 1.18, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:bd4343ed-67a7-1707-4d4e-7f4b161c0d5a", "resource": { "resourceType": "ExplanationOfBenefit", "id": "bd4343ed-67a7-1707-4d4e-7f4b161c0d5a", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e145f926-6970-d1f9-8cf0-47f6a06c0555" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-11-26T23:26:11-05:00", "end": "2009-11-26T23:26:11-05:00" }, "created": "2008-11-26T23:26:11-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "claim": { "reference": "urn:uuid:e145f926-6970-d1f9-8cf0-47f6a06c0555" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2008-11-26T23:11:11-05:00", "end": "2008-11-26T23:26:11-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:95e46130-a4d2-f7c6-c007-6a9cfa7410b8" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1.18, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f825a6ad-4e27-289a-986f-0e1902d7eb40", "resource": { "resourceType": "DiagnosticReport", "id": "f825a6ad-4e27-289a-986f-0e1902d7eb40", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:95e46130-a4d2-f7c6-c007-6a9cfa7410b8" }, "effectiveDateTime": "2008-11-26T23:11:11-05:00", "issued": "2008-11-26T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:981bf2b4-83a0-207d-1e31-1fb6d6db7e23", "resource": { "resourceType": "DocumentReference", "id": "981bf2b4-83a0-207d-1e31-1fb6d6db7e23", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:f825a6ad-4e27-289a-986f-0e1902d7eb40" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2008-11-26T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "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:95e46130-a4d2-f7c6-c007-6a9cfa7410b8" } ], "period": { "start": "2008-11-26T23:11:11-05:00", "end": "2008-11-26T23:26:11-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:61c70009-0957-e7c2-ea9d-85cb96f3df53", "resource": { "resourceType": "Claim", "id": "61c70009-0957-e7c2-ea9d-85cb96f3df53", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2008-11-26T23:11:11-05:00", "end": "2008-11-26T23:26:11-05:00" }, "created": "2008-11-26T23:26:11-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "390906007", "display": "Follow-up encounter (procedure)" } ], "text": "Follow-up encounter (procedure)" }, "encounter": [ { "reference": "urn:uuid:95e46130-a4d2-f7c6-c007-6a9cfa7410b8" } ] } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:4e51ff28-9c63-81e2-eb8f-93cc9f32594d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "4e51ff28-9c63-81e2-eb8f-93cc9f32594d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "61c70009-0957-e7c2-ea9d-85cb96f3df53" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2008-11-26T23:26:11-05:00", "end": "2009-11-26T23:26:11-05:00" }, "created": "2008-11-26T23:26:11-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "claim": { "reference": "urn:uuid:61c70009-0957-e7c2-ea9d-85cb96f3df53" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "390906007", "display": "Follow-up encounter (procedure)" } ], "text": "Follow-up encounter (procedure)" }, "servicedPeriod": { "start": "2008-11-26T23:11:11-05:00", "end": "2008-11-26T23:26:11-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:95e46130-a4d2-f7c6-c007-6a9cfa7410b8" } ] } ], "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:408910e7-1f17-d20c-3ceb-39210ac50615", "resource": { "resourceType": "Encounter", "id": "408910e7-1f17-d20c-3ceb-39210ac50615", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "408910e7-1f17-d20c-3ceb-39210ac50615" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:843ea112-0fa7-f609-3ad0-eaddf1b05ab0", "resource": { "resourceType": "Condition", "id": "843ea112-0fa7-f609-3ad0-eaddf1b05ab0", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" }, "onsetDateTime": "2009-11-02T23:58:39-05:00", "abatementDateTime": "2018-12-24T23:57:31-05:00", "recordedDate": "2009-11-02T23:58:39-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:b8db4c6f-4482-3463-f27c-d0708b1505ae", "resource": { "resourceType": "MedicationRequest", "id": "b8db4c6f-4482-3463-f27c-d0708b1505ae", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" }, "authoredOn": "2009-11-02T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:986200e9-0419-0c96-8976-03556b314c78", "resource": { "resourceType": "Claim", "id": "986200e9-0419-0c96-8976-03556b314c78", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" }, "created": "2009-11-02T23:58:39-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:b8db4c6f-4482-3463-f27c-d0708b1505ae" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" } ] } ], "total": { "value": 0.45, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:1d795229-7204-560b-23f0-0d86c9b283eb", "resource": { "resourceType": "ExplanationOfBenefit", "id": "1d795229-7204-560b-23f0-0d86c9b283eb", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "986200e9-0419-0c96-8976-03556b314c78" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2009-11-02T23:58:39-05:00", "end": "2010-11-02T23:58:39-04:00" }, "created": "2009-11-02T23:58:39-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:986200e9-0419-0c96-8976-03556b314c78" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.45, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:900a78b9-f447-bf05-d9b3-c412df7e8915", "resource": { "resourceType": "MedicationRequest", "id": "900a78b9-f447-bf05-d9b3-c412df7e8915", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" }, "authoredOn": "2009-11-02T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:9b711a8a-f234-78ce-7aa1-ee4bd7c9f0b3", "resource": { "resourceType": "Claim", "id": "9b711a8a-f234-78ce-7aa1-ee4bd7c9f0b3", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" }, "created": "2009-11-02T23:58:39-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:900a78b9-f447-bf05-d9b3-c412df7e8915" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:fb012dc4-57d1-6f68-7b5b-08b1cd302820", "resource": { "resourceType": "ExplanationOfBenefit", "id": "fb012dc4-57d1-6f68-7b5b-08b1cd302820", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "9b711a8a-f234-78ce-7aa1-ee4bd7c9f0b3" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2009-11-02T23:58:39-05:00", "end": "2010-11-02T23:58:39-04:00" }, "created": "2009-11-02T23:58:39-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:9b711a8a-f234-78ce-7aa1-ee4bd7c9f0b3" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:cfb86295-50f2-52ed-7c22-f0c1fa18bb73", "resource": { "resourceType": "MedicationRequest", "id": "cfb86295-50f2-52ed-7c22-f0c1fa18bb73", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" }, "authoredOn": "2009-11-02T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:e571ead0-1e70-94a3-62a0-44a7feddc1d4", "resource": { "resourceType": "Claim", "id": "e571ead0-1e70-94a3-62a0-44a7feddc1d4", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" }, "created": "2009-11-02T23:58:39-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:cfb86295-50f2-52ed-7c22-f0c1fa18bb73" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" } ] } ], "total": { "value": 0.93, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:d799f9d5-a4ac-bf3e-b287-6f345d643f58", "resource": { "resourceType": "ExplanationOfBenefit", "id": "d799f9d5-a4ac-bf3e-b287-6f345d643f58", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e571ead0-1e70-94a3-62a0-44a7feddc1d4" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2009-11-02T23:58:39-05:00", "end": "2010-11-02T23:58:39-04:00" }, "created": "2009-11-02T23:58:39-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:e571ead0-1e70-94a3-62a0-44a7feddc1d4" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.93, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:ed48d042-0618-8fc2-f695-bdb89c30e476", "resource": { "resourceType": "DiagnosticReport", "id": "ed48d042-0618-8fc2-f695-bdb89c30e476", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" }, "effectiveDateTime": "2009-11-02T23:11:11-05:00", "issued": "2009-11-02T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:9f6175d6-9cfd-2b95-6207-16200468e046", "resource": { "resourceType": "DocumentReference", "id": "9f6175d6-9cfd-2b95-6207-16200468e046", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:ed48d042-0618-8fc2-f695-bdb89c30e476" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2009-11-02T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" } ], "period": { "start": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:82257b40-6222-5bcc-791f-78619e87d8a2", "resource": { "resourceType": "Claim", "id": "82257b40-6222-5bcc-791f-78619e87d8a2", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" }, "created": "2009-11-02T23:58:39-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:843ea112-0fa7-f609-3ad0-eaddf1b05ab0" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" } ] }, { "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": 778.78, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:4b01d103-03d0-1795-cb5b-abf0792ed04c", "resource": { "resourceType": "ExplanationOfBenefit", "id": "4b01d103-03d0-1795-cb5b-abf0792ed04c", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "82257b40-6222-5bcc-791f-78619e87d8a2" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2009-11-02T23:58:39-05:00", "end": "2010-11-02T23:58:39-04:00" }, "created": "2009-11-02T23:58:39-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:82257b40-6222-5bcc-791f-78619e87d8a2" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:843ea112-0fa7-f609-3ad0-eaddf1b05ab0" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" } ] }, { "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": "2009-11-02T23:11:11-05:00", "end": "2009-11-02T23:58:39-05:00" }, "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": 778.78, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4", "resource": { "resourceType": "Encounter", "id": "7199857b-c4f3-5bd3-de25-828d62b8e7d4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "7199857b-c4f3-5bd3-de25-828d62b8e7d4" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:9d953d66-1511-350f-8e50-dde187a16bdd", "resource": { "resourceType": "Condition", "id": "9d953d66-1511-350f-8e50-dde187a16bdd", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" }, "onsetDateTime": "2010-11-09T00:09:57-05:00", "abatementDateTime": "2014-12-01T23:50:29-05:00", "recordedDate": "2010-11-09T00:09:57-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:b3bcc536-73ff-5b22-9e6d-619422951cea", "resource": { "resourceType": "SupplyDelivery", "id": "b3bcc536-73ff-5b22-9e6d-619422951cea", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2010-11-08T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:074f67cb-a119-3533-d441-23e24ef9d8c9", "resource": { "resourceType": "MedicationRequest", "id": "074f67cb-a119-3533-d441-23e24ef9d8c9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" }, "authoredOn": "2010-11-08T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:e303123c-c79a-8fb6-a29a-67da6583f327", "resource": { "resourceType": "Claim", "id": "e303123c-c79a-8fb6-a29a-67da6583f327", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "created": "2010-11-09T00:09:57-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:074f67cb-a119-3533-d441-23e24ef9d8c9" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" } ] } ], "total": { "value": 0.60, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:393fd91b-8501-8747-26b6-94b9b447c774", "resource": { "resourceType": "ExplanationOfBenefit", "id": "393fd91b-8501-8747-26b6-94b9b447c774", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e303123c-c79a-8fb6-a29a-67da6583f327" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2010-11-09T00:09:57-05:00", "end": "2011-11-09T00:09:57-05:00" }, "created": "2010-11-09T00:09:57-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:e303123c-c79a-8fb6-a29a-67da6583f327" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.60, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:06c6a0e0-9b6e-c456-f00a-c9916246a75f", "resource": { "resourceType": "MedicationRequest", "id": "06c6a0e0-9b6e-c456-f00a-c9916246a75f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" }, "authoredOn": "2010-11-08T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:6d08121b-81cc-8b12-33bb-c4860244a88f", "resource": { "resourceType": "Claim", "id": "6d08121b-81cc-8b12-33bb-c4860244a88f", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "created": "2010-11-09T00:09:57-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:06c6a0e0-9b6e-c456-f00a-c9916246a75f" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:30783dd1-1d35-2dfa-ff8f-e0f123abe957", "resource": { "resourceType": "ExplanationOfBenefit", "id": "30783dd1-1d35-2dfa-ff8f-e0f123abe957", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "6d08121b-81cc-8b12-33bb-c4860244a88f" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2010-11-09T00:09:57-05:00", "end": "2011-11-09T00:09:57-05:00" }, "created": "2010-11-09T00:09:57-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:6d08121b-81cc-8b12-33bb-c4860244a88f" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:fd0dcb0e-303e-fd5d-2167-177791a4e854", "resource": { "resourceType": "MedicationRequest", "id": "fd0dcb0e-303e-fd5d-2167-177791a4e854", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" }, "authoredOn": "2010-11-08T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:1ac58b78-6c99-c49f-e95c-10c8487fa848", "resource": { "resourceType": "Claim", "id": "1ac58b78-6c99-c49f-e95c-10c8487fa848", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "created": "2010-11-09T00:09:57-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:fd0dcb0e-303e-fd5d-2167-177791a4e854" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" } ] } ], "total": { "value": 1.05, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:02c47fbc-7ac2-4300-eb8c-815a2999b6c5", "resource": { "resourceType": "ExplanationOfBenefit", "id": "02c47fbc-7ac2-4300-eb8c-815a2999b6c5", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "1ac58b78-6c99-c49f-e95c-10c8487fa848" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2010-11-09T00:09:57-05:00", "end": "2011-11-09T00:09:57-05:00" }, "created": "2010-11-09T00:09:57-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:1ac58b78-6c99-c49f-e95c-10c8487fa848" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1.05, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a29f9e9c-1403-2bde-23c5-3c4ae6c63675", "resource": { "resourceType": "DiagnosticReport", "id": "a29f9e9c-1403-2bde-23c5-3c4ae6c63675", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" }, "effectiveDateTime": "2010-11-08T23:11:11-05:00", "issued": "2010-11-08T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:b4bb60e2-6a6f-298c-cd10-14ebb75ca022", "resource": { "resourceType": "DocumentReference", "id": "b4bb60e2-6a6f-298c-cd10-14ebb75ca022", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:a29f9e9c-1403-2bde-23c5-3c4ae6c63675" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2010-11-08T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMTAtMTEtMDgKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkFhcm9uNjk3CiBpcyBhIDM2IHllYXItb2xkIG5vbmhpc3BhbmljIHdoaXRlIG1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBwYXJ0LXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIGZ1bGwtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKS4KCiMgU29jaWFsIEhpc3RvcnkKUGF0aWVudCBpcyBtYXJyaWVkLiBQYXRpZW50IGhhcyBuZXZlciBzbW9rZWQuCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLgoKUGF0aWVudCBjb21lcyBmcm9tIGEgaGlnaCBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCiBQYXRpZW50IGlzIGEgY29sbGVnZSBncmFkdWF0ZS4KUGF0aWVudCBjdXJyZW50bHkgaGFzIFVuaXRlZEhlYWx0aGNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCmxpc2lub3ByaWwgMTAgbWcgb3JhbCB0YWJsZXQ7IGh5ZHJvY2hsb3JvdGhpYXppZGUgMjUgbWcgb3JhbCB0YWJsZXQ7IGFtbG9kaXBpbmUgMi41IG1nIG9yYWwgdGFibGV0CgojIEFzc2Vzc21lbnQgYW5kIFBsYW4KUGF0aWVudCBpcyBwcmVzZW50aW5nIHdpdGggc3RyZXNzIChmaW5kaW5nKS4gCgojIyBQbGFuCgpUaGUgcGF0aWVudCB3YXMgcHJlc2NyaWJlZCB0aGUgZm9sbG93aW5nIG1lZGljYXRpb25zOgotIGh5ZHJvY2hsb3JvdGhpYXppZGUgMjUgbWcgb3JhbCB0YWJsZXQKLSBsaXNpbm9wcmlsIDEwIG1nIG9yYWwgdGFibGV0Ci0gYW1sb2RpcGluZSAyLjUgbWcgb3JhbCB0YWJsZXQK" }, "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:7199857b-c4f3-5bd3-de25-828d62b8e7d4" } ], "period": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:9d50d939-f203-21cf-6e81-4f3c57c7d9f8", "resource": { "resourceType": "Claim", "id": "9d50d939-f203-21cf-6e81-4f3c57c7d9f8", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "created": "2010-11-09T00:09:57-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:9d953d66-1511-350f-8e50-dde187a16bdd" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 3, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" } } ], "total": { "value": 785.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:4fa3f59e-46c1-e7aa-3e1c-b2b747759d85", "resource": { "resourceType": "ExplanationOfBenefit", "id": "4fa3f59e-46c1-e7aa-3e1c-b2b747759d85", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "9d50d939-f203-21cf-6e81-4f3c57c7d9f8" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2010-11-09T00:09:57-05:00", "end": "2011-11-09T00:09:57-05:00" }, "created": "2010-11-09T00:09:57-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:9d50d939-f203-21cf-6e81-4f3c57c7d9f8" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:9d953d66-1511-350f-8e50-dde187a16bdd" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" } ] }, { "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://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 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": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" }, "servicedPeriod": { "start": "2010-11-08T23:11:11-05:00", "end": "2010-11-09T00:09:57-05:00" }, "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": 785.58, "currency": "USD" } } ], "payment": { "amount": { "value": 5.44, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156", "resource": { "resourceType": "Encounter", "id": "658b0f66-8e64-5adc-a108-b900eb2a9156", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "658b0f66-8e64-5adc-a108-b900eb2a9156" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:e8252fa8-05dd-0a7c-cf76-7ad6f0baab38", "resource": { "resourceType": "SupplyDelivery", "id": "e8252fa8-05dd-0a7c-cf76-7ad6f0baab38", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2011-11-14T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:cc389283-56d8-d33d-61c2-216efced757b", "resource": { "resourceType": "SupplyDelivery", "id": "cc389283-56d8-d33d-61c2-216efced757b", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 100 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "1137596000", "display": "Blood lancet (physical object)" } ], "text": "Blood lancet (physical object)" } }, "occurrenceDateTime": "2011-11-14T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:fd442b19-cc60-a5cc-11ab-ec7caae2337f", "resource": { "resourceType": "MedicationRequest", "id": "fd442b19-cc60-a5cc-11ab-ec7caae2337f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" }, "authoredOn": "2011-11-14T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:41a79569-93fd-d204-1d85-df98fb50bb90", "resource": { "resourceType": "Claim", "id": "41a79569-93fd-d204-1d85-df98fb50bb90", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "created": "2011-11-14T23:56:44-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:fd442b19-cc60-a5cc-11ab-ec7caae2337f" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" } ] } ], "total": { "value": 0.60, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:9643c909-bb90-b70f-96f7-7ee4adc4bfd2", "resource": { "resourceType": "ExplanationOfBenefit", "id": "9643c909-bb90-b70f-96f7-7ee4adc4bfd2", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "41a79569-93fd-d204-1d85-df98fb50bb90" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2011-11-14T23:56:44-05:00", "end": "2012-11-14T23:56:44-05:00" }, "created": "2011-11-14T23:56:44-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:41a79569-93fd-d204-1d85-df98fb50bb90" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.60, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:7ea6c14f-253d-3de8-e7ca-3a6beaa8327f", "resource": { "resourceType": "MedicationRequest", "id": "7ea6c14f-253d-3de8-e7ca-3a6beaa8327f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" }, "authoredOn": "2011-11-14T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:a0efe435-3579-5a71-bd64-f609d7960412", "resource": { "resourceType": "Claim", "id": "a0efe435-3579-5a71-bd64-f609d7960412", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "created": "2011-11-14T23:56:44-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:7ea6c14f-253d-3de8-e7ca-3a6beaa8327f" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:1a698ea2-4a67-935f-a76b-bf6277550a1b", "resource": { "resourceType": "ExplanationOfBenefit", "id": "1a698ea2-4a67-935f-a76b-bf6277550a1b", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "a0efe435-3579-5a71-bd64-f609d7960412" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2011-11-14T23:56:44-05:00", "end": "2012-11-14T23:56:44-05:00" }, "created": "2011-11-14T23:56:44-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:a0efe435-3579-5a71-bd64-f609d7960412" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:12e11c51-0ff7-2226-bc49-a6a0d8a4c299", "resource": { "resourceType": "MedicationRequest", "id": "12e11c51-0ff7-2226-bc49-a6a0d8a4c299", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" }, "authoredOn": "2011-11-14T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:2927edec-55e0-dfe7-380e-359f78cbd851", "resource": { "resourceType": "Claim", "id": "2927edec-55e0-dfe7-380e-359f78cbd851", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "created": "2011-11-14T23:56:44-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:12e11c51-0ff7-2226-bc49-a6a0d8a4c299" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" } ] } ], "total": { "value": 1.11, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:c8aa673a-b6d7-05ca-0408-165df76335d6", "resource": { "resourceType": "ExplanationOfBenefit", "id": "c8aa673a-b6d7-05ca-0408-165df76335d6", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "2927edec-55e0-dfe7-380e-359f78cbd851" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2011-11-14T23:56:44-05:00", "end": "2012-11-14T23:56:44-05:00" }, "created": "2011-11-14T23:56:44-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:2927edec-55e0-dfe7-380e-359f78cbd851" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1.11, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:b159f80a-c94e-f2f9-12ac-c82ffd04cd52", "resource": { "resourceType": "DiagnosticReport", "id": "b159f80a-c94e-f2f9-12ac-c82ffd04cd52", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" }, "effectiveDateTime": "2011-11-14T23:11:11-05:00", "issued": "2011-11-14T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:2e1d3cf6-5d3a-03b0-dcf0-0000f3bb294d", "resource": { "resourceType": "DocumentReference", "id": "2e1d3cf6-5d3a-03b0-dcf0-0000f3bb294d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:b159f80a-c94e-f2f9-12ac-c82ffd04cd52" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2011-11-14T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" } ], "period": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:0bab0d8f-1da7-ad92-b93d-42da239599fa", "resource": { "resourceType": "Claim", "id": "0bab0d8f-1da7-ad92-b93d-42da239599fa", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "created": "2011-11-14T23:56:44-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 3, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "1137596000", "display": "Blood lancet (physical object)" } ], "text": "Blood lancet (physical object)" }, "net": { "value": 0.00, "currency": "USD" } } ], "total": { "value": 1585.73, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:4a88e78b-908e-0efa-fe3e-c27dc496d1fa", "resource": { "resourceType": "ExplanationOfBenefit", "id": "4a88e78b-908e-0efa-fe3e-c27dc496d1fa", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "0bab0d8f-1da7-ad92-b93d-42da239599fa" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2011-11-14T23:56:44-05:00", "end": "2012-11-14T23:56:44-05:00" }, "created": "2011-11-14T23:56:44-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:0bab0d8f-1da7-ad92-b93d-42da239599fa" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" } ] }, { "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://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "1137596000", "display": "Blood lancet (physical object)" } ], "text": "Blood lancet (physical object)" }, "servicedPeriod": { "start": "2011-11-14T23:11:11-05:00", "end": "2011-11-14T23:56:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 0.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 0.0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 0.0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 0.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 0.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1585.73, "currency": "USD" } } ], "payment": { "amount": { "value": 5.44, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a", "resource": { "resourceType": "Encounter", "id": "aa6c1074-8311-0ec9-557a-7db276dc5d2a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "aa6c1074-8311-0ec9-557a-7db276dc5d2a" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:82d614a6-72dd-11f2-94bf-c016aa769e96", "resource": { "resourceType": "Condition", "id": "82d614a6-72dd-11f2-94bf-c016aa769e96", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" }, "onsetDateTime": "2012-11-19T23:11:11-05:00", "abatementDateTime": "2013-11-25T23:11:11-05:00", "recordedDate": "2012-11-19T23:11:11-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:d83dcc42-0e34-19dc-a5fb-74bc502e2ae9", "resource": { "resourceType": "SupplyDelivery", "id": "d83dcc42-0e34-19dc-a5fb-74bc502e2ae9", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2012-11-19T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:14be4a47-5585-cb48-e37c-b3abde1a9031", "resource": { "resourceType": "MedicationRequest", "id": "14be4a47-5585-cb48-e37c-b3abde1a9031", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" }, "authoredOn": "2012-11-19T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:82cfd228-f6b5-7324-80ac-8e396e4d4533", "resource": { "resourceType": "Claim", "id": "82cfd228-f6b5-7324-80ac-8e396e4d4533", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "created": "2012-11-19T23:44:04-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:14be4a47-5585-cb48-e37c-b3abde1a9031" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" } ] } ], "total": { "value": 0.63, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:efcc4959-05f1-a68c-a3cf-183071c963de", "resource": { "resourceType": "ExplanationOfBenefit", "id": "efcc4959-05f1-a68c-a3cf-183071c963de", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "82cfd228-f6b5-7324-80ac-8e396e4d4533" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2012-11-19T23:44:04-05:00", "end": "2013-11-19T23:44:04-05:00" }, "created": "2012-11-19T23:44:04-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:82cfd228-f6b5-7324-80ac-8e396e4d4533" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.63, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:981b5542-6cc4-cc10-3647-17d9342a9d9a", "resource": { "resourceType": "MedicationRequest", "id": "981b5542-6cc4-cc10-3647-17d9342a9d9a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" }, "authoredOn": "2012-11-19T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:222c5e0d-b82c-14c0-a037-fc0879bfb188", "resource": { "resourceType": "Claim", "id": "222c5e0d-b82c-14c0-a037-fc0879bfb188", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "created": "2012-11-19T23:44:04-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:981b5542-6cc4-cc10-3647-17d9342a9d9a" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:2e0e565b-140c-45d2-99e6-13acc80f14a9", "resource": { "resourceType": "ExplanationOfBenefit", "id": "2e0e565b-140c-45d2-99e6-13acc80f14a9", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "222c5e0d-b82c-14c0-a037-fc0879bfb188" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2012-11-19T23:44:04-05:00", "end": "2013-11-19T23:44:04-05:00" }, "created": "2012-11-19T23:44:04-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:222c5e0d-b82c-14c0-a037-fc0879bfb188" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:3e33d384-ed26-6948-fe65-d0cb5e28052e", "resource": { "resourceType": "MedicationRequest", "id": "3e33d384-ed26-6948-fe65-d0cb5e28052e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" }, "authoredOn": "2012-11-19T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:57212361-4ab0-d9e7-c170-ea012c5fcc15", "resource": { "resourceType": "Claim", "id": "57212361-4ab0-d9e7-c170-ea012c5fcc15", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "created": "2012-11-19T23:44:04-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:3e33d384-ed26-6948-fe65-d0cb5e28052e" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" } ] } ], "total": { "value": 1.00, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:2bcc4a02-fdd9-ee4e-dfcf-18da69b1ab9f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "2bcc4a02-fdd9-ee4e-dfcf-18da69b1ab9f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "57212361-4ab0-d9e7-c170-ea012c5fcc15" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2012-11-19T23:44:04-05:00", "end": "2013-11-19T23:44:04-05:00" }, "created": "2012-11-19T23:44:04-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:57212361-4ab0-d9e7-c170-ea012c5fcc15" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1.00, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:28b4099b-f9b5-7f4e-530e-0e327070ca5a", "resource": { "resourceType": "DiagnosticReport", "id": "28b4099b-f9b5-7f4e-530e-0e327070ca5a", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" }, "effectiveDateTime": "2012-11-19T23:11:11-05:00", "issued": "2012-11-19T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:39a85eb7-4f82-45c8-1400-c00a1fa7797e", "resource": { "resourceType": "DocumentReference", "id": "39a85eb7-4f82-45c8-1400-c00a1fa7797e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:28b4099b-f9b5-7f4e-530e-0e327070ca5a" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2012-11-19T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" } ], "period": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:6c4fa4fe-a710-2761-09d1-d806f1e3e07c", "resource": { "resourceType": "Claim", "id": "6c4fa4fe-a710-2761-09d1-d806f1e3e07c", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "created": "2012-11-19T23:44:04-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:82d614a6-72dd-11f2-94bf-c016aa769e96" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 3, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } } ], "total": { "value": 785.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:2d6c17ac-dbc4-f143-33e2-d30b99af7ee3", "resource": { "resourceType": "ExplanationOfBenefit", "id": "2d6c17ac-dbc4-f143-33e2-d30b99af7ee3", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "6c4fa4fe-a710-2761-09d1-d806f1e3e07c" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2012-11-19T23:44:04-05:00", "end": "2013-11-19T23:44:04-05:00" }, "created": "2012-11-19T23:44:04-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:6c4fa4fe-a710-2761-09d1-d806f1e3e07c" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:82d614a6-72dd-11f2-94bf-c016aa769e96" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 3, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2012-11-19T23:11:11-05:00", "end": "2012-11-19T23:44:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 785.58, "currency": "USD" } } ], "payment": { "amount": { "value": 5.44, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:b6cc9a12-9fbc-610a-71b6-d85ed7a01800", "resource": { "resourceType": "Encounter", "id": "b6cc9a12-9fbc-610a-71b6-d85ed7a01800", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "b6cc9a12-9fbc-610a-71b6-d85ed7a01800" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2013-09-07T10:11:11-04:00", "end": "2013-09-07T10:26:11-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } } ], "period": { "start": "2013-09-07T10:11:11-04:00", "end": "2013-09-07T10:26:11-04:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "195662009", "display": "Acute viral pharyngitis (disorder)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:12305045-ec8f-298a-1322-4067e84c3628", "resource": { "resourceType": "Condition", "id": "12305045-ec8f-298a-1322-4067e84c3628", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "195662009", "display": "Acute viral pharyngitis (disorder)" } ], "text": "Acute viral pharyngitis (disorder)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b6cc9a12-9fbc-610a-71b6-d85ed7a01800" }, "onsetDateTime": "2013-09-07T10:11:11-04:00", "abatementDateTime": "2013-09-14T23:11:11-04:00", "recordedDate": "2013-09-07T10:11:11-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:e9da4dd0-e393-22fa-7b17-c03c35b0759c", "resource": { "resourceType": "Observation", "id": "e9da4dd0-e393-22fa-7b17-c03c35b0759c", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8310-5", "display": "Body temperature" }, { "system": "http://loinc.org", "code": "8331-1", "display": "Oral temperature" } ], "text": "Body temperature" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b6cc9a12-9fbc-610a-71b6-d85ed7a01800" }, "effectiveDateTime": "2013-09-07T10:11:11-04:00", "issued": "2013-09-07T10:11:11.671-04:00", "valueQuantity": { "value": 37.403, "unit": "Cel", "system": "http://unitsofmeasure.org", "code": "Cel" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d6525ce2-384b-040a-d0f5-646ce413bfec", "resource": { "resourceType": "Procedure", "id": "d6525ce2-384b-040a-d0f5-646ce413bfec", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "117015009", "display": "Throat culture (procedure)" } ], "text": "Throat culture (procedure)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b6cc9a12-9fbc-610a-71b6-d85ed7a01800" }, "performedPeriod": { "start": "2013-09-07T10:11:11-04:00", "end": "2013-09-07T10:26:11-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "reasonReference": [ { "reference": "urn:uuid:12305045-ec8f-298a-1322-4067e84c3628", "display": "Acute viral pharyngitis (disorder)" } ] }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:bb015cc6-82de-b376-cd9b-37b3af0f5cde", "resource": { "resourceType": "DiagnosticReport", "id": "bb015cc6-82de-b376-cd9b-37b3af0f5cde", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b6cc9a12-9fbc-610a-71b6-d85ed7a01800" }, "effectiveDateTime": "2013-09-07T10:11:11-04:00", "issued": "2013-09-07T10:11:11.671-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:ab6272ae-3c5f-6ace-30ad-b3430b36d430", "resource": { "resourceType": "DocumentReference", "id": "ab6272ae-3c5f-6ace-30ad-b3430b36d430", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:bb015cc6-82de-b376-cd9b-37b3af0f5cde" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2013-09-07T10:11:11.671-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "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:b6cc9a12-9fbc-610a-71b6-d85ed7a01800" } ], "period": { "start": "2013-09-07T10:11:11-04:00", "end": "2013-09-07T10:26:11-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:1c76bd3e-5820-e707-351a-ee0af2c92c14", "resource": { "resourceType": "Claim", "id": "1c76bd3e-5820-e707-351a-ee0af2c92c14", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2013-09-07T10:11:11-04:00", "end": "2013-09-07T10:26:11-04:00" }, "created": "2013-09-07T10:26:11-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:12305045-ec8f-298a-1322-4067e84c3628" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:d6525ce2-384b-040a-d0f5-646ce413bfec" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "encounter": [ { "reference": "urn:uuid:b6cc9a12-9fbc-610a-71b6-d85ed7a01800" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "195662009", "display": "Acute viral pharyngitis (disorder)" } ], "text": "Acute viral pharyngitis (disorder)" } }, { "sequence": 3, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "117015009", "display": "Throat culture (procedure)" } ], "text": "Throat culture (procedure)" }, "net": { "value": 2811.35, "currency": "USD" } } ], "total": { "value": 2896.90, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:3c053d54-c48f-6a27-aadf-6d151e6a57a3", "resource": { "resourceType": "ExplanationOfBenefit", "id": "3c053d54-c48f-6a27-aadf-6d151e6a57a3", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "1c76bd3e-5820-e707-351a-ee0af2c92c14" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2013-09-07T10:26:11-04:00", "end": "2014-09-07T10:26:11-04:00" }, "created": "2013-09-07T10:26:11-04:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "claim": { "reference": "urn:uuid:1c76bd3e-5820-e707-351a-ee0af2c92c14" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:12305045-ec8f-298a-1322-4067e84c3628" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "servicedPeriod": { "start": "2013-09-07T10:11:11-04:00", "end": "2013-09-07T10:26:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b6cc9a12-9fbc-610a-71b6-d85ed7a01800" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "195662009", "display": "Acute viral pharyngitis (disorder)" } ], "text": "Acute viral pharyngitis (disorder)" }, "servicedPeriod": { "start": "2013-09-07T10:11:11-04:00", "end": "2013-09-07T10:26:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "117015009", "display": "Throat culture (procedure)" } ], "text": "Throat culture (procedure)" }, "servicedPeriod": { "start": "2013-09-07T10:11:11-04:00", "end": "2013-09-07T10:26:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 2811.35, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 562.27, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 2249.08, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 2811.35, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 2811.35, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 2896.90, "currency": "USD" } } ], "payment": { "amount": { "value": 2249.08, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043", "resource": { "resourceType": "Encounter", "id": "d23629d7-b5c3-09bc-d415-fd9b143cf043", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "d23629d7-b5c3-09bc-d415-fd9b143cf043" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:e03513f1-2186-bc69-a227-f0b0a544fff5", "resource": { "resourceType": "Observation", "id": "e03513f1-2186-bc69-a227-f0b0a544fff5", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4548-4", "display": "Hemoglobin A1c/Hemoglobin.total in Blood" } ], "text": "Hemoglobin A1c/Hemoglobin.total in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 6.3, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:104cabb7-cbca-78fc-6d5f-f02226ca6c7e", "resource": { "resourceType": "Observation", "id": "104cabb7-cbca-78fc-6d5f-f02226ca6c7e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 172.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6f5dc2cd-f93c-4e2b-ff45-94ecd4a3111a", "resource": { "resourceType": "Observation", "id": "6f5dc2cd-f93c-4e2b-ff45-94ecd4a3111a", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 3, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:03aa1992-db72-eae3-6645-fa7cc618cc09", "resource": { "resourceType": "Observation", "id": "03aa1992-db72-eae3-6645-fa7cc618cc09", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 81.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:51bd2316-0938-a3bf-2901-bb4ffe6b344f", "resource": { "resourceType": "Observation", "id": "51bd2316-0938-a3bf-2901-bb4ffe6b344f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 27.19, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:862f85ce-cb71-5db5-9edb-339fc7b55375", "resource": { "resourceType": "Observation", "id": "862f85ce-cb71-5db5-9edb-339fc7b55375", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 88, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 133, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cd025b72-0936-d2ad-b31c-4815c57ae0a0", "resource": { "resourceType": "Observation", "id": "cd025b72-0936-d2ad-b31c-4815c57ae0a0", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 77, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:79b73bb4-ec99-f0b0-6b8a-bfd8a8262f9e", "resource": { "resourceType": "Observation", "id": "79b73bb4-ec99-f0b0-6b8a-bfd8a8262f9e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 15, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6677f847-f292-a5f1-215e-49daf4e1c7ea", "resource": { "resourceType": "Observation", "id": "6677f847-f292-a5f1-215e-49daf4e1c7ea", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2339-0", "display": "Glucose [Mass/volume] in Blood" } ], "text": "Glucose [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 99.91, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d8387fe8-b45b-01cd-bfa8-c9676c2b01c7", "resource": { "resourceType": "Observation", "id": "d8387fe8-b45b-01cd-bfa8-c9676c2b01c7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6299-2", "display": "Urea nitrogen [Mass/volume] in Blood" } ], "text": "Urea nitrogen [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 10.3, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:db22f0c5-9db1-38a3-8da7-e3b3dfdc8344", "resource": { "resourceType": "Observation", "id": "db22f0c5-9db1-38a3-8da7-e3b3dfdc8344", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "38483-4", "display": "Creatinine [Mass/volume] in Blood" } ], "text": "Creatinine [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 1.14, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8599c81d-1437-923b-4a86-de273a5719f1", "resource": { "resourceType": "Observation", "id": "8599c81d-1437-923b-4a86-de273a5719f1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "49765-1", "display": "Calcium [Mass/volume] in Blood" } ], "text": "Calcium [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 9.46, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2b8fdaff-aa19-6d3f-c5ab-4eb091d2ad6c", "resource": { "resourceType": "Observation", "id": "2b8fdaff-aa19-6d3f-c5ab-4eb091d2ad6c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2947-0", "display": "Sodium [Moles/volume] in Blood" } ], "text": "Sodium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 137.25, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4a609758-3b38-85e9-3e71-ee73f833473c", "resource": { "resourceType": "Observation", "id": "4a609758-3b38-85e9-3e71-ee73f833473c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6298-4", "display": "Potassium [Moles/volume] in Blood" } ], "text": "Potassium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 5.08, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7afcd12b-7d5b-73fd-4213-72ac3a8643dd", "resource": { "resourceType": "Observation", "id": "7afcd12b-7d5b-73fd-4213-72ac3a8643dd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2069-3", "display": "Chloride [Moles/volume] in Blood" } ], "text": "Chloride [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 107.91, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0ac0a020-e5f1-93fa-9783-8fcbc8f9011b", "resource": { "resourceType": "Observation", "id": "0ac0a020-e5f1-93fa-9783-8fcbc8f9011b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "20565-8", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ], "text": "Carbon dioxide, total [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 24.32, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a9fbfd50-fc57-9dd6-bf2e-3188135baf8a", "resource": { "resourceType": "Observation", "id": "a9fbfd50-fc57-9dd6-bf2e-3188135baf8a", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 5.4133, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e6b0b119-1caa-fad1-f4ab-a848b339d909", "resource": { "resourceType": "Observation", "id": "e6b0b119-1caa-fad1-f4ab-a848b339d909", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 4.9575, "unit": "10*6/uL", "system": "http://unitsofmeasure.org", "code": "10*6/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9face90f-b8ca-be4a-7d6a-ac6d5cbf3861", "resource": { "resourceType": "Observation", "id": "9face90f-b8ca-be4a-7d6a-ac6d5cbf3861", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 16.826, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7278cfe5-c337-eb1d-154b-e2f1b12095ab", "resource": { "resourceType": "Observation", "id": "7278cfe5-c337-eb1d-154b-e2f1b12095ab", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 38.036, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1af9dd5e-e710-6ae8-8b14-ec50f4009537", "resource": { "resourceType": "Observation", "id": "1af9dd5e-e710-6ae8-8b14-ec50f4009537", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 84.591, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b42b3946-79ea-4b08-8f02-4d3d32414df0", "resource": { "resourceType": "Observation", "id": "b42b3946-79ea-4b08-8f02-4d3d32414df0", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 27.519, "unit": "pg", "system": "http://unitsofmeasure.org", "code": "pg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9c3da9e1-786e-78db-39a4-ec88d03a6b9f", "resource": { "resourceType": "Observation", "id": "9c3da9e1-786e-78db-39a4-ec88d03a6b9f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 33.183, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0d8599ae-7583-cabf-348f-a4bb9cfd8622", "resource": { "resourceType": "Observation", "id": "0d8599ae-7583-cabf-348f-a4bb9cfd8622", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 43.893, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9d92224e-a22e-7849-ed6c-340851d4cdeb", "resource": { "resourceType": "Observation", "id": "9d92224e-a22e-7849-ed6c-340851d4cdeb", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 286, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:18d35af3-1f32-cfa0-16d5-3f9a4218eb6e", "resource": { "resourceType": "Observation", "id": "18d35af3-1f32-cfa0-16d5-3f9a4218eb6e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 405.42, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5cd0f6a1-12c1-470b-00e0-3770a857c242", "resource": { "resourceType": "Observation", "id": "5cd0f6a1-12c1-470b-00e0-3770a857c242", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueQuantity": { "value": 9.5469, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a7903e50-479e-021e-cc90-aa367359eccd", "resource": { "resourceType": "Observation", "id": "a7903e50-479e-021e-cc90-aa367359eccd", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9d7c9d1a-a92e-2c44-daf8-8c7d2434a908", "resource": { "resourceType": "Observation", "id": "9d7c9d1a-a92e-2c44-daf8-8c7d2434a908", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:45:59-05:00", "issued": "2013-11-25T23:45:59.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA13909-9", "display": "Somewhat" } ], "text": "Somewhat" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30131-9", "display": "3 to 5 times a week" } ], "text": "3 to 5 times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "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": 417100, "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": "LA30193-9", "display": "More than high school" } ], "text": "More than high school" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Stroman Way" }, { "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": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 6, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:396867b8-bdc2-e705-83c0-7b5a27e69442", "resource": { "resourceType": "Observation", "id": "396867b8-bdc2-e705-83c0-7b5a27e69442", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-26T00:27:13-05:00", "issued": "2013-11-26T00:27:13.671-05:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:306a37fd-5ab0-3364-185d-0a97161ef342", "resource": { "resourceType": "Observation", "id": "306a37fd-5ab0-3364-185d-0a97161ef342", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-26T01:01:06-05:00", "issued": "2013-11-26T01:01:06.671-05:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8402bc9b-a3e0-4428-641a-6662f0629c55", "resource": { "resourceType": "Procedure", "id": "8402bc9b-a3e0-4428-641a-6662f0629c55", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "performedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:26:11-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1f00d380-3de6-e6ae-c820-dd5d0b9ddeff", "resource": { "resourceType": "Procedure", "id": "1f00d380-3de6-e6ae-c820-dd5d0b9ddeff", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "performedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:33c63707-f031-ac7c-ec3e-4efad2994085", "resource": { "resourceType": "Procedure", "id": "33c63707-f031-ac7c-ec3e-4efad2994085", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "performedPeriod": { "start": "2013-11-25T23:45:59-05:00", "end": "2013-11-26T00:27:13-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b5764826-ba27-4d5d-9b42-e90a6816ebaf", "resource": { "resourceType": "Procedure", "id": "b5764826-ba27-4d5d-9b42-e90a6816ebaf", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "performedPeriod": { "start": "2013-11-26T00:27:13-05:00", "end": "2013-11-26T00:39:35-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:d68b71f5-b770-6edb-38d7-c89752b020f0", "resource": { "resourceType": "Procedure", "id": "d68b71f5-b770-6edb-38d7-c89752b020f0", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "performedPeriod": { "start": "2013-11-26T00:39:35-05:00", "end": "2013-11-26T01:01:06-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:0c6ea7bd-5b3e-0dea-1dfd-bbf7efe9792a", "resource": { "resourceType": "SupplyDelivery", "id": "0c6ea7bd-5b3e-0dea-1dfd-bbf7efe9792a", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2013-11-25T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:ddcb2eb1-4cfd-ef34-4d74-5e077cedfec4", "resource": { "resourceType": "MedicationRequest", "id": "ddcb2eb1-4cfd-ef34-4d74-5e077cedfec4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "authoredOn": "2013-11-25T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:59908909-691b-d31b-78fd-776bedd848f9", "resource": { "resourceType": "Claim", "id": "59908909-691b-d31b-78fd-776bedd848f9", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "created": "2013-11-25T23:45:59-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:ddcb2eb1-4cfd-ef34-4d74-5e077cedfec4" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" } ] } ], "total": { "value": 0.69, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e475ca6e-d0ac-3457-43ab-1e71b0b2ab13", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e475ca6e-d0ac-3457-43ab-1e71b0b2ab13", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "59908909-691b-d31b-78fd-776bedd848f9" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2013-11-25T23:45:59-05:00", "end": "2014-11-25T23:45:59-05:00" }, "created": "2013-11-25T23:45:59-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:59908909-691b-d31b-78fd-776bedd848f9" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.69, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a7e73b9b-561b-13d1-151b-ff947aa5d5ad", "resource": { "resourceType": "MedicationRequest", "id": "a7e73b9b-561b-13d1-151b-ff947aa5d5ad", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "authoredOn": "2013-11-25T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:3a9d115f-b0ac-2fc7-f97c-d34a155b837f", "resource": { "resourceType": "Claim", "id": "3a9d115f-b0ac-2fc7-f97c-d34a155b837f", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "created": "2013-11-25T23:45:59-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:a7e73b9b-561b-13d1-151b-ff947aa5d5ad" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f94786ff-c467-2fcc-4953-07199f54aca2", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f94786ff-c467-2fcc-4953-07199f54aca2", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "3a9d115f-b0ac-2fc7-f97c-d34a155b837f" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2013-11-25T23:45:59-05:00", "end": "2014-11-25T23:45:59-05:00" }, "created": "2013-11-25T23:45:59-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:3a9d115f-b0ac-2fc7-f97c-d34a155b837f" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:4dc1da1a-7b4f-4437-909d-dd458eb202b2", "resource": { "resourceType": "MedicationRequest", "id": "4dc1da1a-7b4f-4437-909d-dd458eb202b2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "authoredOn": "2013-11-25T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:3645ce80-bcbe-60a2-74c2-b40db8102b9a", "resource": { "resourceType": "Claim", "id": "3645ce80-bcbe-60a2-74c2-b40db8102b9a", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "created": "2013-11-25T23:45:59-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:4dc1da1a-7b4f-4437-909d-dd458eb202b2" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" } ] } ], "total": { "value": 0.98, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:edb50283-6725-76d5-ee1c-6e395a7ab703", "resource": { "resourceType": "ExplanationOfBenefit", "id": "edb50283-6725-76d5-ee1c-6e395a7ab703", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "3645ce80-bcbe-60a2-74c2-b40db8102b9a" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2013-11-25T23:45:59-05:00", "end": "2014-11-25T23:45:59-05:00" }, "created": "2013-11-25T23:45:59-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:3645ce80-bcbe-60a2-74c2-b40db8102b9a" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.98, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:e0b1ff88-1c3f-84e9-c815-880cc370e894", "resource": { "resourceType": "Immunization", "id": "e0b1ff88-1c3f-84e9-c815-880cc370e894", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "occurrenceDateTime": "2013-11-25T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:ed8b1142-e08f-cf8b-f19a-8ae6ab5b9da3", "resource": { "resourceType": "DiagnosticReport", "id": "ed8b1142-e08f-cf8b-f19a-8ae6ab5b9da3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:6677f847-f292-a5f1-215e-49daf4e1c7ea", "display": "Glucose [Mass/volume] in Blood" }, { "reference": "urn:uuid:d8387fe8-b45b-01cd-bfa8-c9676c2b01c7", "display": "Urea nitrogen [Mass/volume] in Blood" }, { "reference": "urn:uuid:db22f0c5-9db1-38a3-8da7-e3b3dfdc8344", "display": "Creatinine [Mass/volume] in Blood" }, { "reference": "urn:uuid:8599c81d-1437-923b-4a86-de273a5719f1", "display": "Calcium [Mass/volume] in Blood" }, { "reference": "urn:uuid:2b8fdaff-aa19-6d3f-c5ab-4eb091d2ad6c", "display": "Sodium [Moles/volume] in Blood" }, { "reference": "urn:uuid:4a609758-3b38-85e9-3e71-ee73f833473c", "display": "Potassium [Moles/volume] in Blood" }, { "reference": "urn:uuid:7afcd12b-7d5b-73fd-4213-72ac3a8643dd", "display": "Chloride [Moles/volume] in Blood" }, { "reference": "urn:uuid:0ac0a020-e5f1-93fa-9783-8fcbc8f9011b", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:4f8c2933-42ae-f57c-c950-9b1f3480d110", "resource": { "resourceType": "DiagnosticReport", "id": "4f8c2933-42ae-f57c-c950-9b1f3480d110", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:a9fbfd50-fc57-9dd6-bf2e-3188135baf8a", "display": "Leukocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:e6b0b119-1caa-fad1-f4ab-a848b339d909", "display": "Erythrocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:9face90f-b8ca-be4a-7d6a-ac6d5cbf3861", "display": "Hemoglobin [Mass/volume] in Blood" }, { "reference": "urn:uuid:7278cfe5-c337-eb1d-154b-e2f1b12095ab", "display": "Hematocrit [Volume Fraction] of Blood by Automated count" }, { "reference": "urn:uuid:1af9dd5e-e710-6ae8-8b14-ec50f4009537", "display": "MCV [Entitic volume] by Automated count" }, { "reference": "urn:uuid:b42b3946-79ea-4b08-8f02-4d3d32414df0", "display": "MCH [Entitic mass] by Automated count" }, { "reference": "urn:uuid:9c3da9e1-786e-78db-39a4-ec88d03a6b9f", "display": "MCHC [Mass/volume] by Automated count" }, { "reference": "urn:uuid:0d8599ae-7583-cabf-348f-a4bb9cfd8622", "display": "Erythrocyte distribution width [Entitic volume] by Automated count" }, { "reference": "urn:uuid:9d92224e-a22e-7849-ed6c-340851d4cdeb", "display": "Platelets [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:18d35af3-1f32-cfa0-16d5-3f9a4218eb6e", "display": "Platelet distribution width [Entitic volume] in Blood by Automated count" }, { "reference": "urn:uuid:5cd0f6a1-12c1-470b-00e0-3770a857c242", "display": "Platelet mean volume [Entitic volume] in Blood by Automated count" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:49b2bbfd-233c-03cd-586b-fccb24ef79f7", "resource": { "resourceType": "DiagnosticReport", "id": "49b2bbfd-233c-03cd-586b-fccb24ef79f7", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-26T00:27:13-05:00", "issued": "2013-11-26T00:27:13.671-05:00", "result": [ { "reference": "urn:uuid:396867b8-bdc2-e705-83c0-7b5a27e69442", "display": "Total score [HARK]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:84df709d-a9f4-24ab-43d8-3f2de137f78e", "resource": { "resourceType": "DiagnosticReport", "id": "84df709d-a9f4-24ab-43d8-3f2de137f78e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-26T01:01:06-05:00", "issued": "2013-11-26T01:01:06.671-05:00", "result": [ { "reference": "urn:uuid:306a37fd-5ab0-3364-185d-0a97161ef342", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:e6186caa-4a46-9c43-fe6d-20b3973412d9", "resource": { "resourceType": "DiagnosticReport", "id": "e6186caa-4a46-9c43-fe6d-20b3973412d9", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, "effectiveDateTime": "2013-11-25T23:11:11-05:00", "issued": "2013-11-25T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:ba7dc30b-a6c3-bda8-2632-73ce4c640710", "resource": { "resourceType": "DocumentReference", "id": "ba7dc30b-a6c3-bda8-2632-73ce4c640710", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:e6186caa-4a46-9c43-fe6d-20b3973412d9" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2013-11-25T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" } ], "period": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:94148b62-832d-3e59-782c-b4a9eed96294", "resource": { "resourceType": "Claim", "id": "94148b62-832d-3e59-782c-b4a9eed96294", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "created": "2013-11-25T23:45:59-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:e0b1ff88-1c3f-84e9-c815-880cc370e894" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 6, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:8402bc9b-a3e0-4428-641a-6662f0629c55" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:1f00d380-3de6-e6ae-c820-dd5d0b9ddeff" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:33c63707-f031-ac7c-ec3e-4efad2994085" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:b5764826-ba27-4d5d-9b42-e90a6816ebaf" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:d68b71f5-b770-6edb-38d7-c89752b020f0" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" } ] }, { "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": 544.78, "currency": "USD" } }, { "sequence": 4, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "informationSequence": [ 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": 10, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "informationSequence": [ 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" } } ], "total": { "value": 1404.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:6b06ae4c-b4c7-dcb6-97f4-250b1f6fe276", "resource": { "resourceType": "ExplanationOfBenefit", "id": "6b06ae4c-b4c7-dcb6-97f4-250b1f6fe276", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "94148b62-832d-3e59-782c-b4a9eed96294" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2013-11-25T23:45:59-05:00", "end": "2014-11-25T23:45:59-05:00" }, "created": "2013-11-25T23:45:59-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:94148b62-832d-3e59-782c-b4a9eed96294" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 544.78, "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": 108.956, "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": 435.824, "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": 544.78, "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": 544.78, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "informationSequence": [ 5 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "informationSequence": [ 6 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2013-11-25T23:11:11-05:00", "end": "2013-11-25T23:45:59-05:00" }, "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": 1404.94, "currency": "USD" } } ], "payment": { "amount": { "value": 2169.2000000000003, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73", "resource": { "resourceType": "Encounter", "id": "4059839e-793a-d0c3-79fe-cea1e2ea0a73", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "4059839e-793a-d0c3-79fe-cea1e2ea0a73" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:56c7cb60-d934-8948-06dc-2942f3cee2f2", "resource": { "resourceType": "Condition", "id": "56c7cb60-d934-8948-06dc-2942f3cee2f2", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "onsetDateTime": "2014-12-01T23:11:11-05:00", "abatementDateTime": "2014-12-01T23:11:11-05:00", "recordedDate": "2014-12-01T23:11:11-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:59069952-f167-a058-cb9c-4ebcdfcf1845", "resource": { "resourceType": "Observation", "id": "59069952-f167-a058-cb9c-4ebcdfcf1845", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4548-4", "display": "Hemoglobin A1c/Hemoglobin.total in Blood" } ], "text": "Hemoglobin A1c/Hemoglobin.total in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 6.03, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ba582c78-5e97-7475-1cc6-81b226367d6f", "resource": { "resourceType": "Observation", "id": "ba582c78-5e97-7475-1cc6-81b226367d6f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 172.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cda1fb31-8c9b-9729-3bc6-e687b5678641", "resource": { "resourceType": "Observation", "id": "cda1fb31-8c9b-9729-3bc6-e687b5678641", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 3, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cea98653-a117-8a6a-bcdf-20f4de6dddbf", "resource": { "resourceType": "Observation", "id": "cea98653-a117-8a6a-bcdf-20f4de6dddbf", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 81.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:588b7e9b-dc6f-e52a-195b-525006d9024c", "resource": { "resourceType": "Observation", "id": "588b7e9b-dc6f-e52a-195b-525006d9024c", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 27.19, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b4391a65-40e6-f132-262b-089e7c9f7b7f", "resource": { "resourceType": "Observation", "id": "b4391a65-40e6-f132-262b-089e7c9f7b7f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 83, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 123, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e910cf4e-d12f-2c9f-6c89-cb518598e3d6", "resource": { "resourceType": "Observation", "id": "e910cf4e-d12f-2c9f-6c89-cb518598e3d6", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 92, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:daa32f4e-227c-74be-c0f9-1963dbe4487d", "resource": { "resourceType": "Observation", "id": "daa32f4e-227c-74be-c0f9-1963dbe4487d", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 16, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:329c15f9-9180-752a-3f13-07b9fb507600", "resource": { "resourceType": "Observation", "id": "329c15f9-9180-752a-3f13-07b9fb507600", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2339-0", "display": "Glucose [Mass/volume] in Blood" } ], "text": "Glucose [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 77.81, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:748db7c8-d2fc-8966-7c46-c7db86423eae", "resource": { "resourceType": "Observation", "id": "748db7c8-d2fc-8966-7c46-c7db86423eae", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6299-2", "display": "Urea nitrogen [Mass/volume] in Blood" } ], "text": "Urea nitrogen [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 13.31, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b490d022-d300-0b88-b9ae-c98ec227f305", "resource": { "resourceType": "Observation", "id": "b490d022-d300-0b88-b9ae-c98ec227f305", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "38483-4", "display": "Creatinine [Mass/volume] in Blood" } ], "text": "Creatinine [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 1.13, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d7ea6c3e-c388-5e65-257d-2318fbc0e809", "resource": { "resourceType": "Observation", "id": "d7ea6c3e-c388-5e65-257d-2318fbc0e809", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "49765-1", "display": "Calcium [Mass/volume] in Blood" } ], "text": "Calcium [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 9.09, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:408bf0d7-8113-1334-e636-f015ea074f8b", "resource": { "resourceType": "Observation", "id": "408bf0d7-8113-1334-e636-f015ea074f8b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2947-0", "display": "Sodium [Moles/volume] in Blood" } ], "text": "Sodium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 137.63, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:59a1471f-307a-4571-ba46-498acea8d0ad", "resource": { "resourceType": "Observation", "id": "59a1471f-307a-4571-ba46-498acea8d0ad", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6298-4", "display": "Potassium [Moles/volume] in Blood" } ], "text": "Potassium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 3.84, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d5a064f3-47e0-5103-ab2b-2b3af151a4a4", "resource": { "resourceType": "Observation", "id": "d5a064f3-47e0-5103-ab2b-2b3af151a4a4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2069-3", "display": "Chloride [Moles/volume] in Blood" } ], "text": "Chloride [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 110.71, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:25cca44d-a91e-46a0-8f44-da38bd063bbf", "resource": { "resourceType": "Observation", "id": "25cca44d-a91e-46a0-8f44-da38bd063bbf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "20565-8", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ], "text": "Carbon dioxide, total [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 27.87, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:92507ba6-06a5-08f0-0863-f33ba75f7fea", "resource": { "resourceType": "Observation", "id": "92507ba6-06a5-08f0-0863-f33ba75f7fea", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 204.51, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8a5df4ca-024a-8e19-355d-52b34c2371b3", "resource": { "resourceType": "Observation", "id": "8a5df4ca-024a-8e19-355d-52b34c2371b3", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 118.58, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a62e6b71-3a5b-4ac0-52b8-8041802a73da", "resource": { "resourceType": "Observation", "id": "a62e6b71-3a5b-4ac0-52b8-8041802a73da", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 144.22, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e724dbbf-fe73-843f-ac3b-d5ffd9cfee22", "resource": { "resourceType": "Observation", "id": "e724dbbf-fe73-843f-ac3b-d5ffd9cfee22", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueQuantity": { "value": 36.57, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bd58e18d-885b-2f4a-e0c7-58e254e2e51a", "resource": { "resourceType": "Observation", "id": "bd58e18d-885b-2f4a-e0c7-58e254e2e51a", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1f87036f-6aac-41ca-4cb7-139a12d9e00e", "resource": { "resourceType": "Observation", "id": "1f87036f-6aac-41ca-4cb7-139a12d9e00e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:50:29-05:00", "issued": "2014-12-01T23:50:29.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30131-9", "display": "3 to 5 times a week" } ], "text": "3 to 5 times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 417100, "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": "LA30193-9", "display": "More than high school" } ], "text": "More than high school" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Stroman Way" }, { "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": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 6, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0c5b4a0d-e66d-0895-4cd4-0cc8a7a97a47", "resource": { "resourceType": "Observation", "id": "0c5b4a0d-e66d-0895-4cd4-0cc8a7a97a47", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-02T00:20:44-05:00", "issued": "2014-12-02T00:20:44.671-05:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:18c1de69-efb8-efbd-7cee-d3420ff47032", "resource": { "resourceType": "Observation", "id": "18c1de69-efb8-efbd-7cee-d3420ff47032", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-02T00:57:19-05:00", "issued": "2014-12-02T00:57:19.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d33befd7-6380-a5b0-6f39-0aa62bcd9d65", "resource": { "resourceType": "Observation", "id": "d33befd7-6380-a5b0-6f39-0aa62bcd9d65", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-02T01:38:53-05:00", "issued": "2014-12-02T01:38:53.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9fdb3ebe-4a64-da12-98ab-7f3177149217", "resource": { "resourceType": "Procedure", "id": "9fdb3ebe-4a64-da12-98ab-7f3177149217", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "performedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:26:11-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:68453cdb-8892-7e56-3b77-afefe96440d1", "resource": { "resourceType": "Procedure", "id": "68453cdb-8892-7e56-3b77-afefe96440d1", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "performedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1bcf80d0-978c-d4c9-1bdf-2e6c84f48175", "resource": { "resourceType": "Procedure", "id": "1bcf80d0-978c-d4c9-1bdf-2e6c84f48175", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "performedPeriod": { "start": "2014-12-01T23:50:29-05:00", "end": "2014-12-02T00:20:44-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:585434f3-ea4d-ddee-74d0-4d26bcb431ad", "resource": { "resourceType": "Procedure", "id": "585434f3-ea4d-ddee-74d0-4d26bcb431ad", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "performedPeriod": { "start": "2014-12-02T00:20:44-05:00", "end": "2014-12-02T00:33:38-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1379d61b-7320-8b3d-a5c2-7a065224473a", "resource": { "resourceType": "Procedure", "id": "1379d61b-7320-8b3d-a5c2-7a065224473a", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "performedPeriod": { "start": "2014-12-02T00:33:38-05:00", "end": "2014-12-02T00:57:19-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:51e599db-8079-540d-fd55-5cb1f425d60e", "resource": { "resourceType": "Procedure", "id": "51e599db-8079-540d-fd55-5cb1f425d60e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "performedPeriod": { "start": "2014-12-02T00:57:19-05:00", "end": "2014-12-02T01:09:56-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:d45581c0-3fc2-f1ad-fa95-97a7de238932", "resource": { "resourceType": "Procedure", "id": "d45581c0-3fc2-f1ad-fa95-97a7de238932", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "performedPeriod": { "start": "2014-12-02T01:09:56-05:00", "end": "2014-12-02T01:38:53-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:95e1b306-573f-049f-c737-34748959e5b5", "resource": { "resourceType": "SupplyDelivery", "id": "95e1b306-573f-049f-c737-34748959e5b5", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2014-12-01T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:9e9e7208-94a3-116f-4740-905c93d7a7d9", "resource": { "resourceType": "SupplyDelivery", "id": "9e9e7208-94a3-116f-4740-905c93d7a7d9", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 100 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "1137596000", "display": "Blood lancet (physical object)" } ], "text": "Blood lancet (physical object)" } }, "occurrenceDateTime": "2014-12-01T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:77b3deb1-c7ea-d849-0f69-a0cb7ed2afe9", "resource": { "resourceType": "MedicationRequest", "id": "77b3deb1-c7ea-d849-0f69-a0cb7ed2afe9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "authoredOn": "2014-12-01T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:e8290f08-5747-e6c4-c8c8-f31bd1de25bf", "resource": { "resourceType": "Claim", "id": "e8290f08-5747-e6c4-c8c8-f31bd1de25bf", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "created": "2014-12-01T23:50:29-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:77b3deb1-c7ea-d849-0f69-a0cb7ed2afe9" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" } ] } ], "total": { "value": 0.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:bef2ec4f-a4e0-ffa6-6dca-d77f02e90144", "resource": { "resourceType": "ExplanationOfBenefit", "id": "bef2ec4f-a4e0-ffa6-6dca-d77f02e90144", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e8290f08-5747-e6c4-c8c8-f31bd1de25bf" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2014-12-01T23:50:29-05:00", "end": "2015-12-01T23:50:29-05:00" }, "created": "2014-12-01T23:50:29-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:e8290f08-5747-e6c4-c8c8-f31bd1de25bf" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.55, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:0c4c5885-79e7-4d56-aff3-31ade319387f", "resource": { "resourceType": "MedicationRequest", "id": "0c4c5885-79e7-4d56-aff3-31ade319387f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "authoredOn": "2014-12-01T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:a7bffd11-4110-64f2-4fe1-da5515b519a4", "resource": { "resourceType": "Claim", "id": "a7bffd11-4110-64f2-4fe1-da5515b519a4", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "created": "2014-12-01T23:50:29-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:0c4c5885-79e7-4d56-aff3-31ade319387f" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:ce660bfa-4e43-e1ca-09c3-bbd0acfff1d6", "resource": { "resourceType": "ExplanationOfBenefit", "id": "ce660bfa-4e43-e1ca-09c3-bbd0acfff1d6", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "a7bffd11-4110-64f2-4fe1-da5515b519a4" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2014-12-01T23:50:29-05:00", "end": "2015-12-01T23:50:29-05:00" }, "created": "2014-12-01T23:50:29-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:a7bffd11-4110-64f2-4fe1-da5515b519a4" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:22c3565c-b371-4297-a0cf-258db3f352f7", "resource": { "resourceType": "MedicationRequest", "id": "22c3565c-b371-4297-a0cf-258db3f352f7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "authoredOn": "2014-12-01T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:15e73242-6a72-7e2a-e368-7b6640ec69ec", "resource": { "resourceType": "Claim", "id": "15e73242-6a72-7e2a-e368-7b6640ec69ec", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "created": "2014-12-01T23:50:29-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:22c3565c-b371-4297-a0cf-258db3f352f7" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" } ] } ], "total": { "value": 1.16, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:03c21cec-ff30-4eb4-7be2-2363ba8ffb71", "resource": { "resourceType": "ExplanationOfBenefit", "id": "03c21cec-ff30-4eb4-7be2-2363ba8ffb71", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "15e73242-6a72-7e2a-e368-7b6640ec69ec" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2014-12-01T23:50:29-05:00", "end": "2015-12-01T23:50:29-05:00" }, "created": "2014-12-01T23:50:29-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:15e73242-6a72-7e2a-e368-7b6640ec69ec" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1.16, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:b96de3fd-0981-69e0-81cf-da91cc3f7932", "resource": { "resourceType": "Immunization", "id": "b96de3fd-0981-69e0-81cf-da91cc3f7932", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "occurrenceDateTime": "2014-12-01T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:a33258b4-9ba7-63f9-d020-b06d1852fc00", "resource": { "resourceType": "Immunization", "id": "a33258b4-9ba7-63f9-d020-b06d1852fc00", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "occurrenceDateTime": "2014-12-01T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:1b539e01-dd7a-c270-d2b2-a0be3003aea9", "resource": { "resourceType": "DiagnosticReport", "id": "1b539e01-dd7a-c270-d2b2-a0be3003aea9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:329c15f9-9180-752a-3f13-07b9fb507600", "display": "Glucose [Mass/volume] in Blood" }, { "reference": "urn:uuid:748db7c8-d2fc-8966-7c46-c7db86423eae", "display": "Urea nitrogen [Mass/volume] in Blood" }, { "reference": "urn:uuid:b490d022-d300-0b88-b9ae-c98ec227f305", "display": "Creatinine [Mass/volume] in Blood" }, { "reference": "urn:uuid:d7ea6c3e-c388-5e65-257d-2318fbc0e809", "display": "Calcium [Mass/volume] in Blood" }, { "reference": "urn:uuid:408bf0d7-8113-1334-e636-f015ea074f8b", "display": "Sodium [Moles/volume] in Blood" }, { "reference": "urn:uuid:59a1471f-307a-4571-ba46-498acea8d0ad", "display": "Potassium [Moles/volume] in Blood" }, { "reference": "urn:uuid:d5a064f3-47e0-5103-ab2b-2b3af151a4a4", "display": "Chloride [Moles/volume] in Blood" }, { "reference": "urn:uuid:25cca44d-a91e-46a0-8f44-da38bd063bbf", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:c26092f2-4127-ea55-22cd-d90c46d2eac0", "resource": { "resourceType": "DiagnosticReport", "id": "c26092f2-4127-ea55-22cd-d90c46d2eac0", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:92507ba6-06a5-08f0-0863-f33ba75f7fea", "display": "Cholesterol [Mass/volume] in Serum or Plasma" }, { "reference": "urn:uuid:8a5df4ca-024a-8e19-355d-52b34c2371b3", "display": "Triglycerides" }, { "reference": "urn:uuid:a62e6b71-3a5b-4ac0-52b8-8041802a73da", "display": "Low Density Lipoprotein Cholesterol" }, { "reference": "urn:uuid:e724dbbf-fe73-843f-ac3b-d5ffd9cfee22", "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:6eca3ce9-88cf-6eef-cf76-8617dece1dea", "resource": { "resourceType": "DiagnosticReport", "id": "6eca3ce9-88cf-6eef-cf76-8617dece1dea", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-02T00:20:44-05:00", "issued": "2014-12-02T00:20:44.671-05:00", "result": [ { "reference": "urn:uuid:0c5b4a0d-e66d-0895-4cd4-0cc8a7a97a47", "display": "Total score [HARK]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:e9dd7cb2-eb95-6093-11e7-dec566608327", "resource": { "resourceType": "DiagnosticReport", "id": "e9dd7cb2-eb95-6093-11e7-dec566608327", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-02T00:57:19-05:00", "issued": "2014-12-02T00:57:19.671-05:00", "result": [ { "reference": "urn:uuid:18c1de69-efb8-efbd-7cee-d3420ff47032", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1e62fe13-1c21-7a44-c5d2-c7d618caadad", "resource": { "resourceType": "DiagnosticReport", "id": "1e62fe13-1c21-7a44-c5d2-c7d618caadad", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-02T01:38:53-05:00", "issued": "2014-12-02T01:38:53.671-05:00", "result": [ { "reference": "urn:uuid:d33befd7-6380-a5b0-6f39-0aa62bcd9d65", "display": "Total score [DAST-10]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:8ac1bcc4-89ca-2f76-9d5b-97b1b5fad8de", "resource": { "resourceType": "DiagnosticReport", "id": "8ac1bcc4-89ca-2f76-9d5b-97b1b5fad8de", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, "effectiveDateTime": "2014-12-01T23:11:11-05:00", "issued": "2014-12-01T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:0742712c-3f5f-5b66-8c8d-b1c10e36c4c7", "resource": { "resourceType": "DocumentReference", "id": "0742712c-3f5f-5b66-8c8d-b1c10e36c4c7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:8ac1bcc4-89ca-2f76-9d5b-97b1b5fad8de" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2014-12-01T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" } ], "period": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:5b024704-0a82-40aa-4ceb-ede3d0a04ab0", "resource": { "resourceType": "Claim", "id": "5b024704-0a82-40aa-4ceb-ede3d0a04ab0", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "created": "2014-12-01T23:50:29-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:b96de3fd-0981-69e0-81cf-da91cc3f7932" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:a33258b4-9ba7-63f9-d020-b06d1852fc00" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 6, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 7, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 8, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 9, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:56c7cb60-d934-8948-06dc-2942f3cee2f2" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:9fdb3ebe-4a64-da12-98ab-7f3177149217" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:68453cdb-8892-7e56-3b77-afefe96440d1" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:1bcf80d0-978c-d4c9-1bdf-2e6c84f48175" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:585434f3-ea4d-ddee-74d0-4d26bcb431ad" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:1379d61b-7320-8b3d-a5c2-7a065224473a" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:51e599db-8079-540d-fd55-5cb1f425d60e" } }, { "sequence": 7, "procedureReference": { "reference": "urn:uuid:d45581c0-3fc2-f1ad-fa95-97a7de238932" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" } ] }, { "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, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 5, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 550.09, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 7, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "1137596000", "display": "Blood lancet (physical object)" } ], "text": "Blood lancet (physical object)" }, "net": { "value": 0.00, "currency": "USD" } }, { "sequence": 8, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 9, "informationSequence": [ 6 ], "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": 10, "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": 11, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "informationSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 13, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 14, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 15, "informationSequence": [ 8 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 16, "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": 17, "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": 18, "informationSequence": [ 9 ], "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": 1546.25, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:ce8e33e5-d56d-ffb1-7d66-1f153376014f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "ce8e33e5-d56d-ffb1-7d66-1f153376014f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "5b024704-0a82-40aa-4ceb-ede3d0a04ab0" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2014-12-01T23:50:29-05:00", "end": "2015-12-01T23:50:29-05:00" }, "created": "2014-12-01T23:50:29-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:5b024704-0a82-40aa-4ceb-ede3d0a04ab0" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:56c7cb60-d934-8948-06dc-2942f3cee2f2" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" } ] }, { "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": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "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": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "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, "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": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 550.09, "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": 110.01800000000001, "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": 440.07200000000006, "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": 550.09, "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": 550.09, "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": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "1137596000", "display": "Blood lancet (physical object)" } ], "text": "Blood lancet (physical object)" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 0.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 0.0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 0.0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 0.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 0.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "informationSequence": [ 5 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "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": "57698-3", "display": "Lipid panel with direct LDL - Serum or Plasma" } ], "text": "Lipid panel with direct LDL - Serum or Plasma" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "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": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "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": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "informationSequence": [ 7 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "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": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "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": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 15, "informationSequence": [ 8 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "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": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "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": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "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": [ 9 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "servicedPeriod": { "start": "2014-12-01T23:11:11-05:00", "end": "2014-12-01T23:50:29-05:00" }, "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": 1546.25, "currency": "USD" } } ], "payment": { "amount": { "value": 3032.152, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825", "resource": { "resourceType": "Encounter", "id": "3ce16797-6bca-2293-51f2-15c043382825", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "3ce16797-6bca-2293-51f2-15c043382825" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem" } ], "text": "Encounter for problem" } ], "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2015-01-20T23:11:11-05:00", "end": "2015-01-20T23:26:11-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } } ], "period": { "start": "2015-01-20T23:11:11-05:00", "end": "2015-01-20T23:26:11-05:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "239873007", "display": "Osteoarthritis of knee" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:767d0188-3ab4-3f35-c3f8-5b778d7a96f2", "resource": { "resourceType": "Condition", "id": "767d0188-3ab4-3f35-c3f8-5b778d7a96f2", "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": "239873007", "display": "Osteoarthritis of knee" } ], "text": "Osteoarthritis of knee" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825" }, "onsetDateTime": "2015-01-20T23:11:11-05:00", "recordedDate": "2015-01-20T23:11:11-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:fc74bdd9-f880-380e-6afb-53130e7b5aa7", "resource": { "resourceType": "Observation", "id": "fc74bdd9-f880-380e-6afb-53130e7b5aa7", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825" }, "effectiveDateTime": "2015-01-20T23:11:11-05:00", "issued": "2015-01-20T23:11:11.671-05:00", "valueQuantity": { "value": 6, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:899c6a00-9ec6-8dbe-c04f-78455b8b311b", "resource": { "resourceType": "Device", "id": "899c6a00-9ec6-8dbe-c04f-78455b8b311b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ] }, "udiCarrier": [ { "deviceIdentifier": "48874880609112", "carrierHRF": "(01)48874880609112(11)151230(17)400114(10)36779(21)4574397494" } ], "status": "active", "distinctIdentifier": "48874880609112", "manufactureDate": "2014-12-30T23:11:11-05:00", "expirationDate": "2040-01-14T23:11:11-05:00", "lotNumber": "36779", "serialNumber": "4574397494", "deviceName": [ { "name": "Walker (physical object)", "type": "user-friendly-name" } ], "type": { "coding": [ { "system": "http://snomed.info/sct", "code": "705406009", "display": "Walker (physical object)" } ], "text": "Walker (physical object)" }, "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" } }, "request": { "method": "POST", "url": "Device" } }, { "fullUrl": "urn:uuid:9b8c300d-bb6f-12fa-6fc4-42aa625e9de7", "resource": { "resourceType": "MedicationRequest", "id": "9b8c300d-bb6f-12fa-6fc4-42aa625e9de7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "849574", "display": "Naproxen sodium 220 MG Oral Tablet" } ], "text": "Naproxen sodium 220 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825" }, "authoredOn": "2015-01-20T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" }, "reasonReference": [ { "reference": "urn:uuid:767d0188-3ab4-3f35-c3f8-5b778d7a96f2", "display": "Osteoarthritis of knee" } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:b0abf504-c267-fe82-701e-f84ab72c6cc3", "resource": { "resourceType": "Claim", "id": "b0abf504-c267-fe82-701e-f84ab72c6cc3", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2015-01-20T23:11:11-05:00", "end": "2015-01-20T23:26:11-05:00" }, "created": "2015-01-20T23:26:11-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:9b8c300d-bb6f-12fa-6fc4-42aa625e9de7" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "849574", "display": "Naproxen sodium 220 MG Oral Tablet" } ], "text": "Naproxen sodium 220 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825" } ] } ], "total": { "value": 120.01, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:c080b1a9-84b8-1cc6-7be0-6e7edc58233d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "c080b1a9-84b8-1cc6-7be0-6e7edc58233d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "b0abf504-c267-fe82-701e-f84ab72c6cc3" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2015-01-20T23:26:11-05:00", "end": "2016-01-20T23:26:11-05:00" }, "created": "2015-01-20T23:26:11-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "claim": { "reference": "urn:uuid:b0abf504-c267-fe82-701e-f84ab72c6cc3" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "849574", "display": "Naproxen sodium 220 MG Oral Tablet" } ], "text": "Naproxen sodium 220 MG Oral Tablet" }, "servicedPeriod": { "start": "2015-01-20T23:11:11-05:00", "end": "2015-01-20T23:26:11-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 120.01, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:0f286b67-cb78-84b5-b9d7-ab94b8ef442e", "resource": { "resourceType": "CareTeam", "id": "0f286b67-cb78-84b5-b9d7-ab94b8ef442e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] }, "status": "active", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825" }, "period": { "start": "2015-01-20T23:11:11-05:00" }, "participant": [ { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "116154003", "display": "Patient" } ], "text": "Patient" } ], "member": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "223366009", "display": "Healthcare professional (occupation)" } ], "text": "Healthcare professional (occupation)" } ], "member": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "224891009", "display": "Healthcare services (qualifier value)" } ], "text": "Healthcare services (qualifier value)" } ], "member": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" } } ], "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "239873007", "display": "Osteoarthritis of knee" } ], "text": "Osteoarthritis of knee" } ], "managingOrganization": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" } ] }, "request": { "method": "POST", "url": "CareTeam" } }, { "fullUrl": "urn:uuid:22f7d12f-4187-dea9-b580-c908e41bcebf", "resource": { "resourceType": "CarePlan", "id": "22f7d12f-4187-dea9-b580-c908e41bcebf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] }, "text": { "status": "generated", "div": "
Care Plan for Musculoskeletal care.
Care plan is meant to treat Osteoarthritis of knee.
Activities:
" }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category", "code": "assess-plan" } ] }, { "coding": [ { "system": "http://snomed.info/sct", "code": "408869004", "display": "Musculoskeletal care" } ], "text": "Musculoskeletal care" } ], "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825" }, "period": { "start": "2015-01-20T23:11:11-05:00" }, "careTeam": [ { "reference": "urn:uuid:0f286b67-cb78-84b5-b9d7-ab94b8ef442e" } ], "addresses": [ { "reference": "urn:uuid:767d0188-3ab4-3f35-c3f8-5b778d7a96f2" } ], "activity": [ { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "386294003", "display": "Joint mobility exercises" } ], "text": "Joint mobility exercises" }, "reasonReference": [ { "reference": "urn:uuid:767d0188-3ab4-3f35-c3f8-5b778d7a96f2" } ], "status": "in-progress", "location": { "display": "MARLBOROUGH HOSPITAL CORP" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "266694003", "display": "Heat therapy" } ], "text": "Heat therapy" }, "reasonReference": [ { "reference": "urn:uuid:767d0188-3ab4-3f35-c3f8-5b778d7a96f2" } ], "status": "in-progress", "location": { "display": "MARLBOROUGH HOSPITAL CORP" } } } ] }, "request": { "method": "POST", "url": "CarePlan" } }, { "fullUrl": "urn:uuid:6e97deba-6a1f-ae47-86ec-92c3b70d24dd", "resource": { "resourceType": "DiagnosticReport", "id": "6e97deba-6a1f-ae47-86ec-92c3b70d24dd", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825" }, "effectiveDateTime": "2015-01-20T23:11:11-05:00", "issued": "2015-01-20T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:c42d974f-a254-3ea9-2fe2-481247f48811", "resource": { "resourceType": "DocumentReference", "id": "c42d974f-a254-3ea9-2fe2-481247f48811", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:6e97deba-6a1f-ae47-86ec-92c3b70d24dd" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2015-01-20T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "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:3ce16797-6bca-2293-51f2-15c043382825" } ], "period": { "start": "2015-01-20T23:11:11-05:00", "end": "2015-01-20T23:26:11-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:f6a84725-9a47-db21-4806-8fab2b145201", "resource": { "resourceType": "Claim", "id": "f6a84725-9a47-db21-4806-8fab2b145201", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2015-01-20T23:11:11-05:00", "end": "2015-01-20T23:26:11-05:00" }, "created": "2015-01-20T23:26:11-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:767d0188-3ab4-3f35-c3f8-5b778d7a96f2" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem" } ], "text": "Encounter for problem" }, "encounter": [ { "reference": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "239873007", "display": "Osteoarthritis of knee" } ], "text": "Osteoarthritis of knee" } }, { "sequence": 3, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "705406009", "display": "Walker (physical object)" } ], "text": "Walker (physical object)" }, "net": { "value": 0.00, "currency": "USD" } } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:3522e476-e97e-3e6e-03fa-506e84293271", "resource": { "resourceType": "ExplanationOfBenefit", "id": "3522e476-e97e-3e6e-03fa-506e84293271", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "f6a84725-9a47-db21-4806-8fab2b145201" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2015-01-20T23:26:11-05:00", "end": "2016-01-20T23:26:11-05:00" }, "created": "2015-01-20T23:26:11-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "claim": { "reference": "urn:uuid:f6a84725-9a47-db21-4806-8fab2b145201" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:767d0188-3ab4-3f35-c3f8-5b778d7a96f2" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem" } ], "text": "Encounter for problem" }, "servicedPeriod": { "start": "2015-01-20T23:11:11-05:00", "end": "2015-01-20T23:26:11-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825" } ] }, { "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": "239873007", "display": "Osteoarthritis of knee" } ], "text": "Osteoarthritis of knee" }, "servicedPeriod": { "start": "2015-01-20T23:11:11-05:00", "end": "2015-01-20T23:26:11-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 3, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "705406009", "display": "Walker (physical object)" } ], "text": "Walker (physical object)" }, "servicedPeriod": { "start": "2015-01-20T23:11:11-05:00", "end": "2015-01-20T23:26:11-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 0.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 0.0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 0.0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 0.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 0.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "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:cf07c908-307b-c848-a48c-0f1d8fa4bfb3", "resource": { "resourceType": "Encounter", "id": "cf07c908-307b-c848-a48c-0f1d8fa4bfb3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "cf07c908-307b-c848-a48c-0f1d8fa4bfb3" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:89957403-e199-8cd4-d5b6-6ddc71141ec5", "resource": { "resourceType": "Condition", "id": "89957403-e199-8cd4-d5b6-6ddc71141ec5", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "onsetDateTime": "2015-12-07T23:11:11-05:00", "abatementDateTime": "2016-12-12T23:11:11-05:00", "recordedDate": "2015-12-07T23:11:11-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:5c3d6c90-b8b9-69db-dbb9-4b1e65d2ccc5", "resource": { "resourceType": "Observation", "id": "5c3d6c90-b8b9-69db-dbb9-4b1e65d2ccc5", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4548-4", "display": "Hemoglobin A1c/Hemoglobin.total in Blood" } ], "text": "Hemoglobin A1c/Hemoglobin.total in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 6.32, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:96eaa344-bc28-966d-40d3-29c8a2c8233b", "resource": { "resourceType": "Observation", "id": "96eaa344-bc28-966d-40d3-29c8a2c8233b", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 172.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8c5e5ce1-2e29-f1f1-90ba-6643dc2d24e4", "resource": { "resourceType": "Observation", "id": "8c5e5ce1-2e29-f1f1-90ba-6643dc2d24e4", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:db8e91bc-a541-e56d-7197-ae1962a46083", "resource": { "resourceType": "Observation", "id": "db8e91bc-a541-e56d-7197-ae1962a46083", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 81.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7822c7e7-cf21-0649-ed43-5135663d46ad", "resource": { "resourceType": "Observation", "id": "7822c7e7-cf21-0649-ed43-5135663d46ad", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 27.19, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7755f221-44db-4c25-e078-5fef5eff1199", "resource": { "resourceType": "Observation", "id": "7755f221-44db-4c25-e078-5fef5eff1199", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 83, "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": 128, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cd8c1821-2538-c8a6-a33c-edc12457d610", "resource": { "resourceType": "Observation", "id": "cd8c1821-2538-c8a6-a33c-edc12457d610", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 61, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e89dab52-6864-9814-7948-756d9d7d0452", "resource": { "resourceType": "Observation", "id": "e89dab52-6864-9814-7948-756d9d7d0452", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 13, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2360deab-5dff-ce0c-5b6d-b44aa7ea4665", "resource": { "resourceType": "Observation", "id": "2360deab-5dff-ce0c-5b6d-b44aa7ea4665", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2339-0", "display": "Glucose [Mass/volume] in Blood" } ], "text": "Glucose [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 73.39, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:de33e67c-d7c0-90a7-8d35-872d0a65ea53", "resource": { "resourceType": "Observation", "id": "de33e67c-d7c0-90a7-8d35-872d0a65ea53", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6299-2", "display": "Urea nitrogen [Mass/volume] in Blood" } ], "text": "Urea nitrogen [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 17.19, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9c284f62-a29f-1eb1-db14-29c3d37335a9", "resource": { "resourceType": "Observation", "id": "9c284f62-a29f-1eb1-db14-29c3d37335a9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "38483-4", "display": "Creatinine [Mass/volume] in Blood" } ], "text": "Creatinine [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 1.26, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a06ef7f6-ad63-f427-5042-71f188ba5469", "resource": { "resourceType": "Observation", "id": "a06ef7f6-ad63-f427-5042-71f188ba5469", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "49765-1", "display": "Calcium [Mass/volume] in Blood" } ], "text": "Calcium [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 10.01, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0e59e987-3012-c6d6-3d76-b99e8d486055", "resource": { "resourceType": "Observation", "id": "0e59e987-3012-c6d6-3d76-b99e8d486055", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2947-0", "display": "Sodium [Moles/volume] in Blood" } ], "text": "Sodium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 137.97, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a3d68807-a5f6-2942-0662-11c88a32186d", "resource": { "resourceType": "Observation", "id": "a3d68807-a5f6-2942-0662-11c88a32186d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6298-4", "display": "Potassium [Moles/volume] in Blood" } ], "text": "Potassium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 4.3, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1d464d49-b507-f7c8-5065-12ddaa2c0cb5", "resource": { "resourceType": "Observation", "id": "1d464d49-b507-f7c8-5065-12ddaa2c0cb5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2069-3", "display": "Chloride [Moles/volume] in Blood" } ], "text": "Chloride [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 110.96, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9d4b836c-ca90-f406-1050-de4ca893423a", "resource": { "resourceType": "Observation", "id": "9d4b836c-ca90-f406-1050-de4ca893423a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "20565-8", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ], "text": "Carbon dioxide, total [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueQuantity": { "value": 22.06, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ef78b5d5-a281-3e69-24cd-4930c5995034", "resource": { "resourceType": "Observation", "id": "ef78b5d5-a281-3e69-24cd-4930c5995034", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0bd57425-1f94-2b60-08fe-e70c593fca8f", "resource": { "resourceType": "Observation", "id": "0bd57425-1f94-2b60-08fe-e70c593fca8f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:57:26-05:00", "issued": "2015-12-07T23:57:26.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30131-9", "display": "3 to 5 times a week" } ], "text": "3 to 5 times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 417100, "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": "LA30193-9", "display": "More than high school" } ], "text": "More than high school" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Stroman Way" }, { "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": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 6, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:05cc85fc-9d19-3671-3710-3c870f786fac", "resource": { "resourceType": "Observation", "id": "05cc85fc-9d19-3671-3710-3c870f786fac", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-08T00:14:28-05:00", "issued": "2015-12-08T00:14:28.671-05:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c19ca3d3-9ce1-95ff-d142-775cb822f345", "resource": { "resourceType": "Observation", "id": "c19ca3d3-9ce1-95ff-d142-775cb822f345", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-08T00:52:30-05:00", "issued": "2015-12-08T00:52:30.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:29b8ab7c-7192-1801-86bf-e83d9657e38f", "resource": { "resourceType": "Procedure", "id": "29b8ab7c-7192-1801-86bf-e83d9657e38f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "performedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:92eac34d-569a-6eca-a681-3fd5d0be8eed", "resource": { "resourceType": "Procedure", "id": "92eac34d-569a-6eca-a681-3fd5d0be8eed", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "performedPeriod": { "start": "2015-12-07T23:57:26-05:00", "end": "2015-12-08T00:14:28-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:bc8cc4b5-557c-3f5c-05bb-5d5b89cb07f5", "resource": { "resourceType": "Procedure", "id": "bc8cc4b5-557c-3f5c-05bb-5d5b89cb07f5", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "performedPeriod": { "start": "2015-12-08T00:14:28-05:00", "end": "2015-12-08T00:25:25-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b21717c0-1805-38ad-577e-de9e5251e4b9", "resource": { "resourceType": "Procedure", "id": "b21717c0-1805-38ad-577e-de9e5251e4b9", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "performedPeriod": { "start": "2015-12-08T00:25:25-05:00", "end": "2015-12-08T00:52:30-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1673e908-f29b-4ad1-a1ae-2c742d9beb89", "resource": { "resourceType": "SupplyDelivery", "id": "1673e908-f29b-4ad1-a1ae-2c742d9beb89", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2015-12-07T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:d4ea4536-f24c-e1ed-74f9-9487224d1320", "resource": { "resourceType": "SupplyDelivery", "id": "d4ea4536-f24c-e1ed-74f9-9487224d1320", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 100 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "8537005", "display": "Solution (substance)" } ], "text": "Solution (substance)" } }, "occurrenceDateTime": "2015-12-07T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:e5e77639-514f-d19d-98d4-70ceff7ac4ad", "resource": { "resourceType": "MedicationRequest", "id": "e5e77639-514f-d19d-98d4-70ceff7ac4ad", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "authoredOn": "2015-12-07T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:9e6283bd-a336-e2cc-844a-b4d2c22159f5", "resource": { "resourceType": "Claim", "id": "9e6283bd-a336-e2cc-844a-b4d2c22159f5", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "created": "2015-12-07T23:57:26-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:e5e77639-514f-d19d-98d4-70ceff7ac4ad" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" } ] } ], "total": { "value": 0.50, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:37efe43e-9180-4cee-06c7-5043165df8f1", "resource": { "resourceType": "ExplanationOfBenefit", "id": "37efe43e-9180-4cee-06c7-5043165df8f1", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "9e6283bd-a336-e2cc-844a-b4d2c22159f5" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2015-12-07T23:57:26-05:00", "end": "2016-12-07T23:57:26-05:00" }, "created": "2015-12-07T23:57:26-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:9e6283bd-a336-e2cc-844a-b4d2c22159f5" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.50, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:2c8819b6-59d8-3c1a-66c2-b14c874e12ff", "resource": { "resourceType": "MedicationRequest", "id": "2c8819b6-59d8-3c1a-66c2-b14c874e12ff", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "authoredOn": "2015-12-07T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:4a9c7a9f-bb6d-c9f1-aeff-1375f757a3f9", "resource": { "resourceType": "Claim", "id": "4a9c7a9f-bb6d-c9f1-aeff-1375f757a3f9", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "created": "2015-12-07T23:57:26-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:2c8819b6-59d8-3c1a-66c2-b14c874e12ff" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e862d12c-3f4a-6d79-6d40-7d2f0e21d97e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e862d12c-3f4a-6d79-6d40-7d2f0e21d97e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "4a9c7a9f-bb6d-c9f1-aeff-1375f757a3f9" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2015-12-07T23:57:26-05:00", "end": "2016-12-07T23:57:26-05:00" }, "created": "2015-12-07T23:57:26-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:4a9c7a9f-bb6d-c9f1-aeff-1375f757a3f9" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:33308711-c96b-a50b-abf2-27e79c55316a", "resource": { "resourceType": "MedicationRequest", "id": "33308711-c96b-a50b-abf2-27e79c55316a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "authoredOn": "2015-12-07T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:5478a57b-af20-52c8-a2bd-2db2bbbd7d40", "resource": { "resourceType": "Claim", "id": "5478a57b-af20-52c8-a2bd-2db2bbbd7d40", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "created": "2015-12-07T23:57:26-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:33308711-c96b-a50b-abf2-27e79c55316a" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" } ] } ], "total": { "value": 1.10, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:269c5e24-9c30-bda1-86a2-d4dffc54e48e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "269c5e24-9c30-bda1-86a2-d4dffc54e48e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "5478a57b-af20-52c8-a2bd-2db2bbbd7d40" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2015-12-07T23:57:26-05:00", "end": "2016-12-07T23:57:26-05:00" }, "created": "2015-12-07T23:57:26-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:5478a57b-af20-52c8-a2bd-2db2bbbd7d40" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1.10, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:9c91b907-b73b-40c4-6709-062c812422fb", "resource": { "resourceType": "Immunization", "id": "9c91b907-b73b-40c4-6709-062c812422fb", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "occurrenceDateTime": "2015-12-07T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:d9cb4d38-4c23-7cdb-6f77-8c1b68de2348", "resource": { "resourceType": "Immunization", "id": "d9cb4d38-4c23-7cdb-6f77-8c1b68de2348", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "occurrenceDateTime": "2015-12-07T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:c3be9163-8f57-cac6-16d1-5320a61f94ed", "resource": { "resourceType": "Immunization", "id": "c3be9163-8f57-cac6-16d1-5320a61f94ed", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "occurrenceDateTime": "2015-12-07T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:8282b292-ed9c-327a-253e-255a128d9357", "resource": { "resourceType": "DiagnosticReport", "id": "8282b292-ed9c-327a-253e-255a128d9357", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:2360deab-5dff-ce0c-5b6d-b44aa7ea4665", "display": "Glucose [Mass/volume] in Blood" }, { "reference": "urn:uuid:de33e67c-d7c0-90a7-8d35-872d0a65ea53", "display": "Urea nitrogen [Mass/volume] in Blood" }, { "reference": "urn:uuid:9c284f62-a29f-1eb1-db14-29c3d37335a9", "display": "Creatinine [Mass/volume] in Blood" }, { "reference": "urn:uuid:a06ef7f6-ad63-f427-5042-71f188ba5469", "display": "Calcium [Mass/volume] in Blood" }, { "reference": "urn:uuid:0e59e987-3012-c6d6-3d76-b99e8d486055", "display": "Sodium [Moles/volume] in Blood" }, { "reference": "urn:uuid:a3d68807-a5f6-2942-0662-11c88a32186d", "display": "Potassium [Moles/volume] in Blood" }, { "reference": "urn:uuid:1d464d49-b507-f7c8-5065-12ddaa2c0cb5", "display": "Chloride [Moles/volume] in Blood" }, { "reference": "urn:uuid:9d4b836c-ca90-f406-1050-de4ca893423a", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:0148bf52-3488-4d43-2d6d-60ba6d37dc05", "resource": { "resourceType": "DiagnosticReport", "id": "0148bf52-3488-4d43-2d6d-60ba6d37dc05", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-08T00:14:28-05:00", "issued": "2015-12-08T00:14:28.671-05:00", "result": [ { "reference": "urn:uuid:05cc85fc-9d19-3671-3710-3c870f786fac", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:988d94e7-52c4-9535-2944-b9a9c9d457e4", "resource": { "resourceType": "DiagnosticReport", "id": "988d94e7-52c4-9535-2944-b9a9c9d457e4", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-08T00:52:30-05:00", "issued": "2015-12-08T00:52:30.671-05:00", "result": [ { "reference": "urn:uuid:c19ca3d3-9ce1-95ff-d142-775cb822f345", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:5b01920b-9f6c-888b-6d9b-6cf8cb9d31f3", "resource": { "resourceType": "DiagnosticReport", "id": "5b01920b-9f6c-888b-6d9b-6cf8cb9d31f3", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, "effectiveDateTime": "2015-12-07T23:11:11-05:00", "issued": "2015-12-07T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1a0b17ae-3992-4283-9f56-58430869abe4", "resource": { "resourceType": "DocumentReference", "id": "1a0b17ae-3992-4283-9f56-58430869abe4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:5b01920b-9f6c-888b-6d9b-6cf8cb9d31f3" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2015-12-07T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" } ], "period": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:b61ee916-9688-7802-6c54-397fa95afe4c", "resource": { "resourceType": "Claim", "id": "b61ee916-9688-7802-6c54-397fa95afe4c", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "created": "2015-12-07T23:57:26-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:9c91b907-b73b-40c4-6709-062c812422fb" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:d9cb4d38-4c23-7cdb-6f77-8c1b68de2348" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:c3be9163-8f57-cac6-16d1-5320a61f94ed" } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 6, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 7, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 8, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:89957403-e199-8cd4-d5b6-6ddc71141ec5" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:29b8ab7c-7192-1801-86bf-e83d9657e38f" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:92eac34d-569a-6eca-a681-3fd5d0be8eed" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:bc8cc4b5-557c-3f5c-05bb-5d5b89cb07f5" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:b21717c0-1805-38ad-577e-de9e5251e4b9" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" } ] }, { "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://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 7, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "8537005", "display": "Solution (substance)" } ], "text": "Solution (substance)" }, "net": { "value": 0.00, "currency": "USD" } }, { "sequence": 8, "informationSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 9, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "informationSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 12, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 13, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 14, "informationSequence": [ 8 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 1057.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:1118c36e-fe4c-3144-c699-1d49ebccc1df", "resource": { "resourceType": "ExplanationOfBenefit", "id": "1118c36e-fe4c-3144-c699-1d49ebccc1df", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "b61ee916-9688-7802-6c54-397fa95afe4c" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2015-12-07T23:57:26-05:00", "end": "2016-12-07T23:57:26-05:00" }, "created": "2015-12-07T23:57:26-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:b61ee916-9688-7802-6c54-397fa95afe4c" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:89957403-e199-8cd4-d5b6-6ddc71141ec5" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "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": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "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": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "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": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 6, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "informationSequence": [ 5 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "8537005", "display": "Solution (substance)" } ], "text": "Solution (substance)" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 0.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 0.0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 0.0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 0.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 0.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "informationSequence": [ 6 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "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, "category": { "coding": [ { "system": "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": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "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, "informationSequence": [ 7 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "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": 12, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 13, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "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, "informationSequence": [ 8 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2015-12-07T23:11:11-05:00", "end": "2015-12-07T23:57:26-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1057.58, "currency": "USD" } } ], "payment": { "amount": { "value": 1891.3120000000001, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f9110bf5-6a7b-91b0-02e9-8bd34e4bc232", "resource": { "resourceType": "Encounter", "id": "f9110bf5-6a7b-91b0-02e9-8bd34e4bc232", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "f9110bf5-6a7b-91b0-02e9-8bd34e4bc232" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2016-02-06T17:11:11-05:00", "end": "2016-02-06T17:26:11-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } } ], "period": { "start": "2016-02-06T17:11:11-05:00", "end": "2016-02-06T17:26:11-05:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "195662009", "display": "Acute viral pharyngitis (disorder)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:c4670fdb-6f15-bef6-4eba-2ac290640a62", "resource": { "resourceType": "Condition", "id": "c4670fdb-6f15-bef6-4eba-2ac290640a62", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "195662009", "display": "Acute viral pharyngitis (disorder)" } ], "text": "Acute viral pharyngitis (disorder)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:f9110bf5-6a7b-91b0-02e9-8bd34e4bc232" }, "onsetDateTime": "2016-02-06T17:11:11-05:00", "abatementDateTime": "2016-02-18T20:11:11-05:00", "recordedDate": "2016-02-06T17:11:11-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:78691e7d-5dcb-a564-fb84-7fbb85ccc0b3", "resource": { "resourceType": "Observation", "id": "78691e7d-5dcb-a564-fb84-7fbb85ccc0b3", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8310-5", "display": "Body temperature" }, { "system": "http://loinc.org", "code": "8331-1", "display": "Oral temperature" } ], "text": "Body temperature" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:f9110bf5-6a7b-91b0-02e9-8bd34e4bc232" }, "effectiveDateTime": "2016-02-06T17:11:11-05:00", "issued": "2016-02-06T17:11:11.671-05:00", "valueQuantity": { "value": 37.197, "unit": "Cel", "system": "http://unitsofmeasure.org", "code": "Cel" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:85a6a838-5779-918a-25f0-0fa40c2a5430", "resource": { "resourceType": "DiagnosticReport", "id": "85a6a838-5779-918a-25f0-0fa40c2a5430", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:f9110bf5-6a7b-91b0-02e9-8bd34e4bc232" }, "effectiveDateTime": "2016-02-06T17:11:11-05:00", "issued": "2016-02-06T17:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1b636f20-8b95-b0a2-a178-9c22ded10e47", "resource": { "resourceType": "DocumentReference", "id": "1b636f20-8b95-b0a2-a178-9c22ded10e47", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:85a6a838-5779-918a-25f0-0fa40c2a5430" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2016-02-06T17:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "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:f9110bf5-6a7b-91b0-02e9-8bd34e4bc232" } ], "period": { "start": "2016-02-06T17:11:11-05:00", "end": "2016-02-06T17:26:11-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:6a21d47c-ae45-458d-5395-238935b16042", "resource": { "resourceType": "Claim", "id": "6a21d47c-ae45-458d-5395-238935b16042", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2016-02-06T17:11:11-05:00", "end": "2016-02-06T17:26:11-05:00" }, "created": "2016-02-06T17:26:11-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:c4670fdb-6f15-bef6-4eba-2ac290640a62" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "encounter": [ { "reference": "urn:uuid:f9110bf5-6a7b-91b0-02e9-8bd34e4bc232" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "195662009", "display": "Acute viral pharyngitis (disorder)" } ], "text": "Acute viral pharyngitis (disorder)" } } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:5effa714-223e-0345-bcaf-c2ee6b960e80", "resource": { "resourceType": "ExplanationOfBenefit", "id": "5effa714-223e-0345-bcaf-c2ee6b960e80", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "6a21d47c-ae45-458d-5395-238935b16042" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2016-02-06T17:26:11-05:00", "end": "2017-02-06T17:26:11-05:00" }, "created": "2016-02-06T17:26:11-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "claim": { "reference": "urn:uuid:6a21d47c-ae45-458d-5395-238935b16042" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:c4670fdb-6f15-bef6-4eba-2ac290640a62" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "servicedPeriod": { "start": "2016-02-06T17:11:11-05:00", "end": "2016-02-06T17:26:11-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f9110bf5-6a7b-91b0-02e9-8bd34e4bc232" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "195662009", "display": "Acute viral pharyngitis (disorder)" } ], "text": "Acute viral pharyngitis (disorder)" }, "servicedPeriod": { "start": "2016-02-06T17:11:11-05:00", "end": "2016-02-06T17:26:11-05:00" }, "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:714518d7-9210-708e-cfb9-bc2705d7a886", "resource": { "resourceType": "Encounter", "id": "714518d7-9210-708e-cfb9-bc2705d7a886", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "714518d7-9210-708e-cfb9-bc2705d7a886" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2016-08-18T00:11:11-04:00", "end": "2016-08-18T01:11:11-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999895193", "display": "Dr. Natalya468 Haley279" } } ], "period": { "start": "2016-08-18T00:11:11-04:00", "end": "2016-08-18T01:11:11-04:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "110030002", "display": "Concussion injury of brain (disorder)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|3ddd497e-aaa3-343e-ba14-ec8f3e115633", "display": "LIFE CARE CENTER OF ACTON" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|b3ada130-6443-3a8e-98c7-4ec127a2b0c4", "display": "LIFE CARE CENTER OF ACTON" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:e5d97032-45bc-c175-ed44-1d070d2ccc08", "resource": { "resourceType": "Condition", "id": "e5d97032-45bc-c175-ed44-1d070d2ccc08", "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": "110030002", "display": "Concussion injury of brain (disorder)" } ], "text": "Concussion injury of brain (disorder)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:714518d7-9210-708e-cfb9-bc2705d7a886" }, "onsetDateTime": "2016-08-18T00:11:11-04:00", "abatementDateTime": "2016-09-17T00:11:11-04:00", "recordedDate": "2016-08-18T00:11:11-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:670e9eea-e958-872a-28b2-23152f6ff7e7", "resource": { "resourceType": "Condition", "id": "670e9eea-e958-872a-28b2-23152f6ff7e7", "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": "62106007", "display": "Concussion with no loss of consciousness" } ], "text": "Concussion with no loss of consciousness" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:714518d7-9210-708e-cfb9-bc2705d7a886" }, "onsetDateTime": "2016-08-18T00:11:11-04:00", "abatementDateTime": "2016-09-17T00:11:11-04:00", "recordedDate": "2016-08-18T00:11:11-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:4ab4855e-186a-ca0e-77a1-fc1f043a8dce", "resource": { "resourceType": "CareTeam", "id": "4ab4855e-186a-ca0e-77a1-fc1f043a8dce", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] }, "status": "inactive", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:714518d7-9210-708e-cfb9-bc2705d7a886" }, "period": { "start": "2016-08-18T00:11:11-04:00", "end": "2016-09-17T00:11:11-04:00" }, "participant": [ { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "116154003", "display": "Patient" } ], "text": "Patient" } ], "member": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "223366009", "display": "Healthcare professional (occupation)" } ], "text": "Healthcare professional (occupation)" } ], "member": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999895193", "display": "Dr. Natalya468 Haley279" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "224891009", "display": "Healthcare services (qualifier value)" } ], "text": "Healthcare services (qualifier value)" } ], "member": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|b3ada130-6443-3a8e-98c7-4ec127a2b0c4", "display": "LIFE CARE CENTER OF ACTON" } } ], "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "62106007", "display": "Concussion with no loss of consciousness" } ], "text": "Concussion with no loss of consciousness" } ], "managingOrganization": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|b3ada130-6443-3a8e-98c7-4ec127a2b0c4", "display": "LIFE CARE CENTER OF ACTON" } ] }, "request": { "method": "POST", "url": "CareTeam" } }, { "fullUrl": "urn:uuid:f5317120-dee5-5984-6456-c65e76c050ab", "resource": { "resourceType": "CarePlan", "id": "f5317120-dee5-5984-6456-c65e76c050ab", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] }, "text": { "status": "generated", "div": "
Care Plan for Head injury rehabilitation.
Care plan is meant to treat Concussion with no loss of consciousness.
Activities:
" }, "status": "completed", "intent": "order", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category", "code": "assess-plan" } ] }, { "coding": [ { "system": "http://snomed.info/sct", "code": "47387005", "display": "Head injury rehabilitation" } ], "text": "Head injury rehabilitation" } ], "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:714518d7-9210-708e-cfb9-bc2705d7a886" }, "period": { "start": "2016-08-18T00:11:11-04:00", "end": "2016-09-17T00:11:11-04:00" }, "careTeam": [ { "reference": "urn:uuid:4ab4855e-186a-ca0e-77a1-fc1f043a8dce" } ], "addresses": [ { "reference": "urn:uuid:670e9eea-e958-872a-28b2-23152f6ff7e7" } ], "activity": [ { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "183051005", "display": "Recommendation to rest" } ], "text": "Recommendation to rest" }, "reasonReference": [ { "reference": "urn:uuid:670e9eea-e958-872a-28b2-23152f6ff7e7" } ], "status": "completed", "location": { "display": "LIFE CARE CENTER OF ACTON" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "226138001", "display": "Alcohol-free diet" } ], "text": "Alcohol-free diet" }, "reasonReference": [ { "reference": "urn:uuid:670e9eea-e958-872a-28b2-23152f6ff7e7" } ], "status": "completed", "location": { "display": "LIFE CARE CENTER OF ACTON" } } } ] }, "request": { "method": "POST", "url": "CarePlan" } }, { "fullUrl": "urn:uuid:25a862b1-0eb3-1e5c-d66b-0851581a8a10", "resource": { "resourceType": "DiagnosticReport", "id": "25a862b1-0eb3-1e5c-d66b-0851581a8a10", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:714518d7-9210-708e-cfb9-bc2705d7a886" }, "effectiveDateTime": "2016-08-18T00:11:11-04:00", "issued": "2016-08-18T00:11:11.671-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999895193", "display": "Dr. Natalya468 Haley279" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:e451178c-1a30-7bca-1fae-bd122f5d7e1e", "resource": { "resourceType": "DocumentReference", "id": "e451178c-1a30-7bca-1fae-bd122f5d7e1e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:25a862b1-0eb3-1e5c-d66b-0851581a8a10" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2016-08-18T00:11:11.671-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999895193", "display": "Dr. Natalya468 Haley279" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|b3ada130-6443-3a8e-98c7-4ec127a2b0c4", "display": "LIFE CARE CENTER OF ACTON" }, "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:714518d7-9210-708e-cfb9-bc2705d7a886" } ], "period": { "start": "2016-08-18T00:11:11-04:00", "end": "2016-08-18T01:11:11-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:98a621fd-1bc3-722b-d6d2-1a2f9077d514", "resource": { "resourceType": "Claim", "id": "98a621fd-1bc3-722b-d6d2-1a2f9077d514", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2016-08-18T00:11:11-04:00", "end": "2016-08-18T01:11:11-04:00" }, "created": "2016-08-18T01:11:11-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|b3ada130-6443-3a8e-98c7-4ec127a2b0c4", "display": "LIFE CARE CENTER OF ACTON" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|3ddd497e-aaa3-343e-ba14-ec8f3e115633", "display": "LIFE CARE CENTER OF ACTON" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:e5d97032-45bc-c175-ed44-1d070d2ccc08" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:670e9eea-e958-872a-28b2-23152f6ff7e7" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "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:714518d7-9210-708e-cfb9-bc2705d7a886" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "110030002", "display": "Concussion injury of brain (disorder)" } ], "text": "Concussion injury of brain (disorder)" } }, { "sequence": 3, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "62106007", "display": "Concussion with no loss of consciousness" } ], "text": "Concussion with no loss of consciousness" } } ], "total": { "value": 146.18, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:bac155d7-1939-78c8-3b1b-30c49b111850", "resource": { "resourceType": "ExplanationOfBenefit", "id": "bac155d7-1939-78c8-3b1b-30c49b111850", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999895193" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999895193" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "98a621fd-1bc3-722b-d6d2-1a2f9077d514" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2016-08-18T01:11:11-04:00", "end": "2017-08-18T01:11:11-04:00" }, "created": "2016-08-18T01:11:11-04:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999895193" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|3ddd497e-aaa3-343e-ba14-ec8f3e115633", "display": "LIFE CARE CENTER OF ACTON" }, "claim": { "reference": "urn:uuid:98a621fd-1bc3-722b-d6d2-1a2f9077d514" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999895193" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:e5d97032-45bc-c175-ed44-1d070d2ccc08" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:670e9eea-e958-872a-28b2-23152f6ff7e7" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "50849002", "display": "Emergency room admission (procedure)" } ], "text": "Emergency room admission (procedure)" }, "servicedPeriod": { "start": "2016-08-18T00:11:11-04:00", "end": "2016-08-18T01:11:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:714518d7-9210-708e-cfb9-bc2705d7a886" } ] }, { "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": "110030002", "display": "Concussion injury of brain (disorder)" } ], "text": "Concussion injury of brain (disorder)" }, "servicedPeriod": { "start": "2016-08-18T00:11:11-04:00", "end": "2016-08-18T01:11:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] } }, { "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": "62106007", "display": "Concussion with no loss of consciousness" } ], "text": "Concussion with no loss of consciousness" }, "servicedPeriod": { "start": "2016-08-18T00:11:11-04:00", "end": "2016-08-18T01:11:11-04:00" }, "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": 146.18, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:933cc9dd-170e-1a0f-e9a6-5305d6feece0", "resource": { "resourceType": "Encounter", "id": "933cc9dd-170e-1a0f-e9a6-5305d6feece0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "933cc9dd-170e-1a0f-e9a6-5305d6feece0" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up" } ], "text": "Encounter for check up" } ], "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2016-09-17T00:11:11-04:00", "end": "2016-09-17T00:26:11-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } } ], "period": { "start": "2016-09-17T00:11:11-04:00", "end": "2016-09-17T00:26:11-04:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "62106007", "display": "Concussion with no loss of consciousness" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:8bb98acf-9b16-58c9-def4-e875212b85cb", "resource": { "resourceType": "DiagnosticReport", "id": "8bb98acf-9b16-58c9-def4-e875212b85cb", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:933cc9dd-170e-1a0f-e9a6-5305d6feece0" }, "effectiveDateTime": "2016-09-17T00:11:11-04:00", "issued": "2016-09-17T00:11:11.671-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:6b9de700-1f1d-53cf-1505-f999fa0a8000", "resource": { "resourceType": "DocumentReference", "id": "6b9de700-1f1d-53cf-1505-f999fa0a8000", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:8bb98acf-9b16-58c9-def4-e875212b85cb" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2016-09-17T00:11:11.671-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "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:933cc9dd-170e-1a0f-e9a6-5305d6feece0" } ], "period": { "start": "2016-09-17T00:11:11-04:00", "end": "2016-09-17T00:26:11-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:0268b729-7a0a-b78b-c543-44548043f888", "resource": { "resourceType": "Claim", "id": "0268b729-7a0a-b78b-c543-44548043f888", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2016-09-17T00:11:11-04:00", "end": "2016-09-17T00:26:11-04:00" }, "created": "2016-09-17T00:26:11-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up" } ], "text": "Encounter for check up" }, "encounter": [ { "reference": "urn:uuid:933cc9dd-170e-1a0f-e9a6-5305d6feece0" } ] } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:99ec046d-462c-7e3d-4fc7-0869c49f7ef1", "resource": { "resourceType": "ExplanationOfBenefit", "id": "99ec046d-462c-7e3d-4fc7-0869c49f7ef1", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "0268b729-7a0a-b78b-c543-44548043f888" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2016-09-17T00:26:11-04:00", "end": "2017-09-17T00:26:11-04:00" }, "created": "2016-09-17T00:26:11-04:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "claim": { "reference": "urn:uuid:0268b729-7a0a-b78b-c543-44548043f888" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up" } ], "text": "Encounter for check up" }, "servicedPeriod": { "start": "2016-09-17T00:11:11-04:00", "end": "2016-09-17T00:26:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:933cc9dd-170e-1a0f-e9a6-5305d6feece0" } ] } ], "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:1f411c65-ccd2-5ade-1752-4fbea05cf06f", "resource": { "resourceType": "Encounter", "id": "1f411c65-ccd2-5ade-1752-4fbea05cf06f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "1f411c65-ccd2-5ade-1752-4fbea05cf06f" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:64609afa-25c3-11ac-285b-025e1e74bbe3", "resource": { "resourceType": "Condition", "id": "64609afa-25c3-11ac-285b-025e1e74bbe3", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "onsetDateTime": "2016-12-13T00:01:48-05:00", "abatementDateTime": "2018-12-24T23:57:31-05:00", "recordedDate": "2016-12-13T00:01:48-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:6df6547d-4f34-8700-38b2-222d612291c8", "resource": { "resourceType": "Observation", "id": "6df6547d-4f34-8700-38b2-222d612291c8", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4548-4", "display": "Hemoglobin A1c/Hemoglobin.total in Blood" } ], "text": "Hemoglobin A1c/Hemoglobin.total in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 6.2, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3b0350f6-a9ab-b72c-d327-6ab037615a0e", "resource": { "resourceType": "Observation", "id": "3b0350f6-a9ab-b72c-d327-6ab037615a0e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 172.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4c248001-6ac0-e9f4-d4b5-7dce0663e072", "resource": { "resourceType": "Observation", "id": "4c248001-6ac0-e9f4-d4b5-7dce0663e072", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 3, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f901986e-6f5d-e321-472f-c8682fffecae", "resource": { "resourceType": "Observation", "id": "f901986e-6f5d-e321-472f-c8682fffecae", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 81.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ea145f46-2467-0ef6-db42-f7f723d32890", "resource": { "resourceType": "Observation", "id": "ea145f46-2467-0ef6-db42-f7f723d32890", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 27.19, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:43ec259d-1785-4ac2-89f8-9f9235738176", "resource": { "resourceType": "Observation", "id": "43ec259d-1785-4ac2-89f8-9f9235738176", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 83, "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:100d9778-62b1-1497-fcf1-fa063ffbe821", "resource": { "resourceType": "Observation", "id": "100d9778-62b1-1497-fcf1-fa063ffbe821", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 83, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:592567b1-2419-94b3-589e-1cc6af64801b", "resource": { "resourceType": "Observation", "id": "592567b1-2419-94b3-589e-1cc6af64801b", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 15, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:38f2d12f-6f87-afd6-bcb8-47f0d6fbab28", "resource": { "resourceType": "Observation", "id": "38f2d12f-6f87-afd6-bcb8-47f0d6fbab28", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2339-0", "display": "Glucose [Mass/volume] in Blood" } ], "text": "Glucose [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 65.48, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:198f0340-77d3-05e0-6f84-287c33ea5ddc", "resource": { "resourceType": "Observation", "id": "198f0340-77d3-05e0-6f84-287c33ea5ddc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6299-2", "display": "Urea nitrogen [Mass/volume] in Blood" } ], "text": "Urea nitrogen [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 11.89, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0222e63c-9b7a-9984-53e0-0707f6e13318", "resource": { "resourceType": "Observation", "id": "0222e63c-9b7a-9984-53e0-0707f6e13318", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "38483-4", "display": "Creatinine [Mass/volume] in Blood" } ], "text": "Creatinine [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 1.1, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bd1ff25e-0b74-4304-27c3-e74461fdeb97", "resource": { "resourceType": "Observation", "id": "bd1ff25e-0b74-4304-27c3-e74461fdeb97", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "49765-1", "display": "Calcium [Mass/volume] in Blood" } ], "text": "Calcium [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 9.76, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3b4c066f-a00c-d2d3-adff-9fc427940b2e", "resource": { "resourceType": "Observation", "id": "3b4c066f-a00c-d2d3-adff-9fc427940b2e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2947-0", "display": "Sodium [Moles/volume] in Blood" } ], "text": "Sodium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 136.8, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1f2775c3-58d5-3a7b-a322-1b16cb8b8655", "resource": { "resourceType": "Observation", "id": "1f2775c3-58d5-3a7b-a322-1b16cb8b8655", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6298-4", "display": "Potassium [Moles/volume] in Blood" } ], "text": "Potassium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 4.99, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:afd18167-e0be-dfc0-4d6b-16186bbe43e5", "resource": { "resourceType": "Observation", "id": "afd18167-e0be-dfc0-4d6b-16186bbe43e5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2069-3", "display": "Chloride [Moles/volume] in Blood" } ], "text": "Chloride [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 101.57, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c41eb09b-dd07-7e05-83e9-ef842b057722", "resource": { "resourceType": "Observation", "id": "c41eb09b-dd07-7e05-83e9-ef842b057722", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "20565-8", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ], "text": "Carbon dioxide, total [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueQuantity": { "value": 27.41, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c94f0308-0579-cb48-a7b1-182d3a4bef91", "resource": { "resourceType": "Observation", "id": "c94f0308-0579-cb48-a7b1-182d3a4bef91", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2efea857-8d4f-60c8-d006-7e727c9e11fe", "resource": { "resourceType": "Observation", "id": "2efea857-8d4f-60c8-d006-7e727c9e11fe", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-13T00:01:48-05:00", "issued": "2016-12-13T00:01:48.671-05:00", "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": "LA14072-5", "display": "Unsure" } ], "text": "Unsure" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA13909-9", "display": "Somewhat" } ], "text": "Somewhat" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30131-9", "display": "3 to 5 times a week" } ], "text": "3 to 5 times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "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": 417100, "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": "LA30193-9", "display": "More than high school" } ], "text": "More than high school" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Stroman Way" }, { "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": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 6, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:31deff32-fa35-2d53-0d38-dca0771fb8f6", "resource": { "resourceType": "Observation", "id": "31deff32-fa35-2d53-0d38-dca0771fb8f6", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-13T00:39:06-05:00", "issued": "2016-12-13T00:39:06.671-05:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3e3c8c0b-bf9a-278b-8890-471ebd768460", "resource": { "resourceType": "Observation", "id": "3e3c8c0b-bf9a-278b-8890-471ebd768460", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-13T01:14:24-05:00", "issued": "2016-12-13T01:14:24.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ba3f6772-2493-5095-0f81-8abe286219c9", "resource": { "resourceType": "Procedure", "id": "ba3f6772-2493-5095-0f81-8abe286219c9", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "performedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-12T23:26:11-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:45e5b53c-63c5-e125-1b83-dbfc8c0f26f6", "resource": { "resourceType": "Procedure", "id": "45e5b53c-63c5-e125-1b83-dbfc8c0f26f6", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "performedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:4039da8b-2dd0-2534-34c6-5210e0e9d70b", "resource": { "resourceType": "Procedure", "id": "4039da8b-2dd0-2534-34c6-5210e0e9d70b", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "performedPeriod": { "start": "2016-12-13T00:01:48-05:00", "end": "2016-12-13T00:14:31-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:50825d43-9a8b-1ced-937c-e9245a6b0ecb", "resource": { "resourceType": "Procedure", "id": "50825d43-9a8b-1ced-937c-e9245a6b0ecb", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "performedPeriod": { "start": "2016-12-13T00:14:31-05:00", "end": "2016-12-13T00:39:06-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:2858432b-3356-2906-f090-6a2c701fa717", "resource": { "resourceType": "Procedure", "id": "2858432b-3356-2906-f090-6a2c701fa717", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "performedPeriod": { "start": "2016-12-13T00:39:06-05:00", "end": "2016-12-13T00:50:04-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:0528c518-c916-f251-a9fb-7c5bc9c9381d", "resource": { "resourceType": "Procedure", "id": "0528c518-c916-f251-a9fb-7c5bc9c9381d", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "performedPeriod": { "start": "2016-12-13T00:50:04-05:00", "end": "2016-12-13T01:14:24-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:a22ae39a-902a-8f48-3353-1177a95e32ec", "resource": { "resourceType": "SupplyDelivery", "id": "a22ae39a-902a-8f48-3353-1177a95e32ec", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2016-12-12T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:d51803ab-d757-3653-7b55-48e83b844b66", "resource": { "resourceType": "MedicationRequest", "id": "d51803ab-d757-3653-7b55-48e83b844b66", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "authoredOn": "2016-12-12T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:d996f883-b016-b408-9911-5844225e2d1f", "resource": { "resourceType": "Claim", "id": "d996f883-b016-b408-9911-5844225e2d1f", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "created": "2016-12-13T00:01:48-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:d51803ab-d757-3653-7b55-48e83b844b66" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" } ] } ], "total": { "value": 0.46, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:5fc22cec-e252-b78f-c262-33639db3531f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "5fc22cec-e252-b78f-c262-33639db3531f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "d996f883-b016-b408-9911-5844225e2d1f" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2016-12-13T00:01:48-05:00", "end": "2017-12-13T00:01:48-05:00" }, "created": "2016-12-13T00:01:48-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:d996f883-b016-b408-9911-5844225e2d1f" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.46, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:2fc38f04-d5f2-0cc4-31ba-0d0aeb45b2f4", "resource": { "resourceType": "MedicationRequest", "id": "2fc38f04-d5f2-0cc4-31ba-0d0aeb45b2f4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "authoredOn": "2016-12-12T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:c7ce50fa-eb1e-2f18-3d0a-9e170ad0d129", "resource": { "resourceType": "Claim", "id": "c7ce50fa-eb1e-2f18-3d0a-9e170ad0d129", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "created": "2016-12-13T00:01:48-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:2fc38f04-d5f2-0cc4-31ba-0d0aeb45b2f4" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:d6fd6ac2-f237-6867-9f2e-bace2d9518b5", "resource": { "resourceType": "ExplanationOfBenefit", "id": "d6fd6ac2-f237-6867-9f2e-bace2d9518b5", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c7ce50fa-eb1e-2f18-3d0a-9e170ad0d129" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2016-12-13T00:01:48-05:00", "end": "2017-12-13T00:01:48-05:00" }, "created": "2016-12-13T00:01:48-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:c7ce50fa-eb1e-2f18-3d0a-9e170ad0d129" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:12fc5fb4-47ae-7c72-016a-f5efcea8532e", "resource": { "resourceType": "MedicationRequest", "id": "12fc5fb4-47ae-7c72-016a-f5efcea8532e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "authoredOn": "2016-12-12T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:eb2fd983-9660-0f91-980f-9457a9149439", "resource": { "resourceType": "Claim", "id": "eb2fd983-9660-0f91-980f-9457a9149439", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "created": "2016-12-13T00:01:48-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:12fc5fb4-47ae-7c72-016a-f5efcea8532e" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" } ] } ], "total": { "value": 0.99, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:24123b14-be51-7dac-8fc8-44cdc47b7e13", "resource": { "resourceType": "ExplanationOfBenefit", "id": "24123b14-be51-7dac-8fc8-44cdc47b7e13", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "eb2fd983-9660-0f91-980f-9457a9149439" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2016-12-13T00:01:48-05:00", "end": "2017-12-13T00:01:48-05:00" }, "created": "2016-12-13T00:01:48-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:eb2fd983-9660-0f91-980f-9457a9149439" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.99, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:486c2675-11e0-771f-52fd-7ca7fcad8e94", "resource": { "resourceType": "Immunization", "id": "486c2675-11e0-771f-52fd-7ca7fcad8e94", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "occurrenceDateTime": "2016-12-12T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:c9d7bc7d-ecb7-39ef-1001-5ccc963415fc", "resource": { "resourceType": "DiagnosticReport", "id": "c9d7bc7d-ecb7-39ef-1001-5ccc963415fc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:38f2d12f-6f87-afd6-bcb8-47f0d6fbab28", "display": "Glucose [Mass/volume] in Blood" }, { "reference": "urn:uuid:198f0340-77d3-05e0-6f84-287c33ea5ddc", "display": "Urea nitrogen [Mass/volume] in Blood" }, { "reference": "urn:uuid:0222e63c-9b7a-9984-53e0-0707f6e13318", "display": "Creatinine [Mass/volume] in Blood" }, { "reference": "urn:uuid:bd1ff25e-0b74-4304-27c3-e74461fdeb97", "display": "Calcium [Mass/volume] in Blood" }, { "reference": "urn:uuid:3b4c066f-a00c-d2d3-adff-9fc427940b2e", "display": "Sodium [Moles/volume] in Blood" }, { "reference": "urn:uuid:1f2775c3-58d5-3a7b-a322-1b16cb8b8655", "display": "Potassium [Moles/volume] in Blood" }, { "reference": "urn:uuid:afd18167-e0be-dfc0-4d6b-16186bbe43e5", "display": "Chloride [Moles/volume] in Blood" }, { "reference": "urn:uuid:c41eb09b-dd07-7e05-83e9-ef842b057722", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:80504901-e6b4-5eed-320a-23e9f545ad8a", "resource": { "resourceType": "DiagnosticReport", "id": "80504901-e6b4-5eed-320a-23e9f545ad8a", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-13T00:39:06-05:00", "issued": "2016-12-13T00:39:06.671-05:00", "result": [ { "reference": "urn:uuid:31deff32-fa35-2d53-0d38-dca0771fb8f6", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:3d5b364f-2d49-6501-c048-ea713e248f6d", "resource": { "resourceType": "DiagnosticReport", "id": "3d5b364f-2d49-6501-c048-ea713e248f6d", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-13T01:14:24-05:00", "issued": "2016-12-13T01:14:24.671-05:00", "result": [ { "reference": "urn:uuid:3e3c8c0b-bf9a-278b-8890-471ebd768460", "display": "Total score [AUDIT-C]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:405f6e3e-c757-f063-932f-93727d3248c4", "resource": { "resourceType": "DiagnosticReport", "id": "405f6e3e-c757-f063-932f-93727d3248c4", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, "effectiveDateTime": "2016-12-12T23:11:11-05:00", "issued": "2016-12-12T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:6dd68590-7523-8947-4099-9026f64926f6", "resource": { "resourceType": "DocumentReference", "id": "6dd68590-7523-8947-4099-9026f64926f6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:405f6e3e-c757-f063-932f-93727d3248c4" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2016-12-12T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" } ], "period": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:0436776b-084d-a27c-cdb5-a3178e95b0c9", "resource": { "resourceType": "Claim", "id": "0436776b-084d-a27c-cdb5-a3178e95b0c9", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "created": "2016-12-13T00:01:48-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:486c2675-11e0-771f-52fd-7ca7fcad8e94" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:64609afa-25c3-11ac-285b-025e1e74bbe3" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:ba3f6772-2493-5095-0f81-8abe286219c9" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:45e5b53c-63c5-e125-1b83-dbfc8c0f26f6" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:4039da8b-2dd0-2534-34c6-5210e0e9d70b" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:50825d43-9a8b-1ced-937c-e9245a6b0ecb" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:2858432b-3356-2906-f090-6a2c701fa717" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:0528c518-c916-f251-a9fb-7c5bc9c9381d" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" } ] }, { "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": 739.53, "currency": "USD" } }, { "sequence": 4, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 6, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 7, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" } }, { "sequence": 8, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 13, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 1525.11, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:0a5fc25a-8148-584d-cb96-e31fc17545c3", "resource": { "resourceType": "ExplanationOfBenefit", "id": "0a5fc25a-8148-584d-cb96-e31fc17545c3", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "0436776b-084d-a27c-cdb5-a3178e95b0c9" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2016-12-13T00:01:48-05:00", "end": "2017-12-13T00:01:48-05:00" }, "created": "2016-12-13T00:01:48-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:0436776b-084d-a27c-cdb5-a3178e95b0c9" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:64609afa-25c3-11ac-285b-025e1e74bbe3" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" } ] }, { "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": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "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": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 739.53, "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": 147.906, "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": 591.624, "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": 739.53, "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": 739.53, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "servicedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" }, "servicedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 8, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "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": "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": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "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": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "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": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "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, "category": { "coding": [ { "system": "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": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 13, "informationSequence": [ 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": "2016-12-12T23:11:11-05:00", "end": "2016-12-13T00:01:48-05:00" }, "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": 1525.11, "currency": "USD" } } ], "payment": { "amount": { "value": 2610.456, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae", "resource": { "resourceType": "Encounter", "id": "0afb6d9e-22fe-ac09-6244-c455de7e3aae", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "0afb6d9e-22fe-ac09-6244-c455de7e3aae" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:8f873314-1372-8035-4cd5-65d6e2d4fc0f", "resource": { "resourceType": "Condition", "id": "8f873314-1372-8035-4cd5-65d6e2d4fc0f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "onsetDateTime": "2017-12-18T23:11:11-05:00", "abatementDateTime": "2018-12-24T23:11:11-05:00", "recordedDate": "2017-12-18T23:11:11-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:b03ccf19-9f7c-f45b-a58f-8efdbc5bf173", "resource": { "resourceType": "Observation", "id": "b03ccf19-9f7c-f45b-a58f-8efdbc5bf173", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4548-4", "display": "Hemoglobin A1c/Hemoglobin.total in Blood" } ], "text": "Hemoglobin A1c/Hemoglobin.total in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 6.25, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7d5f46eb-d094-8037-c4f2-d779e7f7951a", "resource": { "resourceType": "Observation", "id": "7d5f46eb-d094-8037-c4f2-d779e7f7951a", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 172.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8ca76c4a-b087-14a4-9a2c-98a3f189f263", "resource": { "resourceType": "Observation", "id": "8ca76c4a-b087-14a4-9a2c-98a3f189f263", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:710d0610-2b99-7a52-1eb9-461fdd2726a3", "resource": { "resourceType": "Observation", "id": "710d0610-2b99-7a52-1eb9-461fdd2726a3", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 81.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7bea288a-a56c-af4a-acbc-f0439596453d", "resource": { "resourceType": "Observation", "id": "7bea288a-a56c-af4a-acbc-f0439596453d", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 27.19, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:96e6fa56-d543-1329-beec-44f4cd9ccdc8", "resource": { "resourceType": "Observation", "id": "96e6fa56-d543-1329-beec-44f4cd9ccdc8", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 88, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 122, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e5cdc575-2b12-5760-b35d-4e29239282e5", "resource": { "resourceType": "Observation", "id": "e5cdc575-2b12-5760-b35d-4e29239282e5", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 79, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f74b9dfc-f6ff-8ea4-9ba8-6403692b5067", "resource": { "resourceType": "Observation", "id": "f74b9dfc-f6ff-8ea4-9ba8-6403692b5067", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 13, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e9e4b4db-5e05-73fa-537b-ecbdfbd6244d", "resource": { "resourceType": "Observation", "id": "e9e4b4db-5e05-73fa-537b-ecbdfbd6244d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2339-0", "display": "Glucose [Mass/volume] in Blood" } ], "text": "Glucose [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 70.82, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:badd9121-0f40-1334-5d27-d080bb6ba1d3", "resource": { "resourceType": "Observation", "id": "badd9121-0f40-1334-5d27-d080bb6ba1d3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6299-2", "display": "Urea nitrogen [Mass/volume] in Blood" } ], "text": "Urea nitrogen [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 10.33, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:00202a10-031a-c30b-6d98-9409035508a8", "resource": { "resourceType": "Observation", "id": "00202a10-031a-c30b-6d98-9409035508a8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "38483-4", "display": "Creatinine [Mass/volume] in Blood" } ], "text": "Creatinine [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 1.09, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:86a7d5f2-8508-ed60-84e8-f423be8310e5", "resource": { "resourceType": "Observation", "id": "86a7d5f2-8508-ed60-84e8-f423be8310e5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "49765-1", "display": "Calcium [Mass/volume] in Blood" } ], "text": "Calcium [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 9.73, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:32ad8c3b-9afa-9092-b89e-6e72f2c43e82", "resource": { "resourceType": "Observation", "id": "32ad8c3b-9afa-9092-b89e-6e72f2c43e82", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2947-0", "display": "Sodium [Moles/volume] in Blood" } ], "text": "Sodium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 138.69, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6953a5ec-6687-020f-b61f-12704e68780a", "resource": { "resourceType": "Observation", "id": "6953a5ec-6687-020f-b61f-12704e68780a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6298-4", "display": "Potassium [Moles/volume] in Blood" } ], "text": "Potassium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 4.33, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5ea2c037-b468-c62d-edc4-deb1d7fad492", "resource": { "resourceType": "Observation", "id": "5ea2c037-b468-c62d-edc4-deb1d7fad492", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2069-3", "display": "Chloride [Moles/volume] in Blood" } ], "text": "Chloride [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 110.13, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4b9fa569-1d3e-913a-4273-2e6f5ef5d4e7", "resource": { "resourceType": "Observation", "id": "4b9fa569-1d3e-913a-4273-2e6f5ef5d4e7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "20565-8", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ], "text": "Carbon dioxide, total [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 21.85, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8f64dc28-b06c-046f-c4c2-f72f6dadfad0", "resource": { "resourceType": "Observation", "id": "8f64dc28-b06c-046f-c4c2-f72f6dadfad0", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 175.46, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a309bb3f-253e-a045-0aa4-c2e351e4e2fe", "resource": { "resourceType": "Observation", "id": "a309bb3f-253e-a045-0aa4-c2e351e4e2fe", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 107.1, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:10123dd0-cc40-0d4f-5720-c43f42961552", "resource": { "resourceType": "Observation", "id": "10123dd0-cc40-0d4f-5720-c43f42961552", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 122.04, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:128867b2-46da-9ba4-7bb6-61173facdf0e", "resource": { "resourceType": "Observation", "id": "128867b2-46da-9ba4-7bb6-61173facdf0e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueQuantity": { "value": 32, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:51f161c6-ee07-09df-f373-82a578ee67c0", "resource": { "resourceType": "Observation", "id": "51f161c6-ee07-09df-f373-82a578ee67c0", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4d561606-a74a-9e21-d255-956d3236a59f", "resource": { "resourceType": "Observation", "id": "4d561606-a74a-9e21-d255-956d3236a59f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:49:33-05:00", "issued": "2017-12-18T23:49:33.671-05:00", "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": "LA13902-4", "display": "Quite a bit" } ], "text": "Quite a 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": "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": 417100, "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": "LA30193-9", "display": "More than high school" } ], "text": "More than high school" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Stroman Way" }, { "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": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 6, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a4fb6084-0606-85fe-a2cd-b4739d2fdfba", "resource": { "resourceType": "Observation", "id": "a4fb6084-0606-85fe-a2cd-b4739d2fdfba", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-19T00:06:13-05:00", "issued": "2017-12-19T00:06:13.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3eb7a88f-e664-56a6-8af6-9fe67d635e8f", "resource": { "resourceType": "Observation", "id": "3eb7a88f-e664-56a6-8af6-9fe67d635e8f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-19T00:49:33-05:00", "issued": "2017-12-19T00:49:33.671-05:00", "valueQuantity": { "value": 2, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9b420eda-8edb-f5fb-6bee-6f2d32ca4e4a", "resource": { "resourceType": "Procedure", "id": "9b420eda-8edb-f5fb-6bee-6f2d32ca4e4a", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "performedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:13b9d7d1-4731-92cf-7354-c40246658e10", "resource": { "resourceType": "Procedure", "id": "13b9d7d1-4731-92cf-7354-c40246658e10", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "performedPeriod": { "start": "2017-12-18T23:49:33-05:00", "end": "2017-12-19T00:06:13-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:a07cbc27-2293-3f74-718d-e00a0a1a904d", "resource": { "resourceType": "Procedure", "id": "a07cbc27-2293-3f74-718d-e00a0a1a904d", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "performedPeriod": { "start": "2017-12-19T00:06:13-05:00", "end": "2017-12-19T00:20:42-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:3b30a2d5-9821-a60e-b908-8353164ef6f8", "resource": { "resourceType": "Procedure", "id": "3b30a2d5-9821-a60e-b908-8353164ef6f8", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "performedPeriod": { "start": "2017-12-19T00:20:42-05:00", "end": "2017-12-19T00:49:33-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:9eda2b8c-1ff9-3e2d-edd1-03c8cf6afbee", "resource": { "resourceType": "SupplyDelivery", "id": "9eda2b8c-1ff9-3e2d-edd1-03c8cf6afbee", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2017-12-18T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:1703ce91-a876-b0d7-7841-7cd49fc87eaf", "resource": { "resourceType": "MedicationRequest", "id": "1703ce91-a876-b0d7-7841-7cd49fc87eaf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "authoredOn": "2017-12-18T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:6164d450-8690-47c5-ee04-884e1b6de277", "resource": { "resourceType": "Claim", "id": "6164d450-8690-47c5-ee04-884e1b6de277", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "created": "2017-12-18T23:49:33-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:1703ce91-a876-b0d7-7841-7cd49fc87eaf" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" } ] } ], "total": { "value": 0.78, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:93033e60-3285-3e90-cdff-412f09f160ef", "resource": { "resourceType": "ExplanationOfBenefit", "id": "93033e60-3285-3e90-cdff-412f09f160ef", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "6164d450-8690-47c5-ee04-884e1b6de277" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2017-12-18T23:49:33-05:00", "end": "2018-12-18T23:49:33-05:00" }, "created": "2017-12-18T23:49:33-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:6164d450-8690-47c5-ee04-884e1b6de277" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.78, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:48f09cfb-5db7-b09f-2b91-03bbf31a590c", "resource": { "resourceType": "MedicationRequest", "id": "48f09cfb-5db7-b09f-2b91-03bbf31a590c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "authoredOn": "2017-12-18T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:f1ab31c3-1c18-00b9-3a53-c9c97f779c41", "resource": { "resourceType": "Claim", "id": "f1ab31c3-1c18-00b9-3a53-c9c97f779c41", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "created": "2017-12-18T23:49:33-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:48f09cfb-5db7-b09f-2b91-03bbf31a590c" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f6d3e033-43c5-2814-3b92-562b4562d6ed", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f6d3e033-43c5-2814-3b92-562b4562d6ed", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "f1ab31c3-1c18-00b9-3a53-c9c97f779c41" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2017-12-18T23:49:33-05:00", "end": "2018-12-18T23:49:33-05:00" }, "created": "2017-12-18T23:49:33-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:f1ab31c3-1c18-00b9-3a53-c9c97f779c41" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:839db0dc-e4cb-b0e4-84cb-dd79c141a129", "resource": { "resourceType": "MedicationRequest", "id": "839db0dc-e4cb-b0e4-84cb-dd79c141a129", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "authoredOn": "2017-12-18T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:01aff673-f092-d056-25c7-48f81b958069", "resource": { "resourceType": "Claim", "id": "01aff673-f092-d056-25c7-48f81b958069", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "created": "2017-12-18T23:49:33-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:839db0dc-e4cb-b0e4-84cb-dd79c141a129" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" } ] } ], "total": { "value": 0.98, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:550b906a-57c2-4643-3014-283916c2f9f9", "resource": { "resourceType": "ExplanationOfBenefit", "id": "550b906a-57c2-4643-3014-283916c2f9f9", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "01aff673-f092-d056-25c7-48f81b958069" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2017-12-18T23:49:33-05:00", "end": "2018-12-18T23:49:33-05:00" }, "created": "2017-12-18T23:49:33-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:01aff673-f092-d056-25c7-48f81b958069" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.98, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:32cc211f-bf94-be74-5c17-009f44822766", "resource": { "resourceType": "Immunization", "id": "32cc211f-bf94-be74-5c17-009f44822766", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "occurrenceDateTime": "2017-12-18T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:2a5c6003-4d32-c5d1-54d6-fb42d9e57c06", "resource": { "resourceType": "DiagnosticReport", "id": "2a5c6003-4d32-c5d1-54d6-fb42d9e57c06", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:e9e4b4db-5e05-73fa-537b-ecbdfbd6244d", "display": "Glucose [Mass/volume] in Blood" }, { "reference": "urn:uuid:badd9121-0f40-1334-5d27-d080bb6ba1d3", "display": "Urea nitrogen [Mass/volume] in Blood" }, { "reference": "urn:uuid:00202a10-031a-c30b-6d98-9409035508a8", "display": "Creatinine [Mass/volume] in Blood" }, { "reference": "urn:uuid:86a7d5f2-8508-ed60-84e8-f423be8310e5", "display": "Calcium [Mass/volume] in Blood" }, { "reference": "urn:uuid:32ad8c3b-9afa-9092-b89e-6e72f2c43e82", "display": "Sodium [Moles/volume] in Blood" }, { "reference": "urn:uuid:6953a5ec-6687-020f-b61f-12704e68780a", "display": "Potassium [Moles/volume] in Blood" }, { "reference": "urn:uuid:5ea2c037-b468-c62d-edc4-deb1d7fad492", "display": "Chloride [Moles/volume] in Blood" }, { "reference": "urn:uuid:4b9fa569-1d3e-913a-4273-2e6f5ef5d4e7", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:26e0c267-f011-1410-8526-a23640ccfaa9", "resource": { "resourceType": "DiagnosticReport", "id": "26e0c267-f011-1410-8526-a23640ccfaa9", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:8f64dc28-b06c-046f-c4c2-f72f6dadfad0", "display": "Cholesterol [Mass/volume] in Serum or Plasma" }, { "reference": "urn:uuid:a309bb3f-253e-a045-0aa4-c2e351e4e2fe", "display": "Triglycerides" }, { "reference": "urn:uuid:10123dd0-cc40-0d4f-5720-c43f42961552", "display": "Low Density Lipoprotein Cholesterol" }, { "reference": "urn:uuid:128867b2-46da-9ba4-7bb6-61173facdf0e", "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:6634a10b-5e13-8103-1188-a0c8abddb500", "resource": { "resourceType": "DiagnosticReport", "id": "6634a10b-5e13-8103-1188-a0c8abddb500", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-19T00:06:13-05:00", "issued": "2017-12-19T00:06:13.671-05:00", "result": [ { "reference": "urn:uuid:a4fb6084-0606-85fe-a2cd-b4739d2fdfba", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:b8d55dda-9866-4749-e225-b432c1fc82b0", "resource": { "resourceType": "DiagnosticReport", "id": "b8d55dda-9866-4749-e225-b432c1fc82b0", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-19T00:49:33-05:00", "issued": "2017-12-19T00:49:33.671-05:00", "result": [ { "reference": "urn:uuid:3eb7a88f-e664-56a6-8af6-9fe67d635e8f", "display": "Total score [DAST-10]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:88560b47-b3cc-589d-dd0a-1494a142eeb5", "resource": { "resourceType": "DiagnosticReport", "id": "88560b47-b3cc-589d-dd0a-1494a142eeb5", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, "effectiveDateTime": "2017-12-18T23:11:11-05:00", "issued": "2017-12-18T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1ee0c726-0ec5-a18a-d391-89cbaf0f08f5", "resource": { "resourceType": "DocumentReference", "id": "1ee0c726-0ec5-a18a-d391-89cbaf0f08f5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:88560b47-b3cc-589d-dd0a-1494a142eeb5" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2017-12-18T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" } ], "period": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:85102589-8403-d44f-2305-1bc8ec969b15", "resource": { "resourceType": "Claim", "id": "85102589-8403-d44f-2305-1bc8ec969b15", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "created": "2017-12-18T23:49:33-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:32cc211f-bf94-be74-5c17-009f44822766" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 6, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:8f873314-1372-8035-4cd5-65d6e2d4fc0f" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:9b420eda-8edb-f5fb-6bee-6f2d32ca4e4a" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:13b9d7d1-4731-92cf-7354-c40246658e10" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:a07cbc27-2293-3f74-718d-e00a0a1a904d" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:3b30a2d5-9821-a60e-b908-8353164ef6f8" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 4, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "net": { "value": 74.58, "currency": "USD" } }, { "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": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 10, "procedureSequence": [ 3 ], "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": [ 4 ], "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": [ 6 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 860.16, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:a46e8cfa-e640-7f24-ad06-5bb9e6f434ff", "resource": { "resourceType": "ExplanationOfBenefit", "id": "a46e8cfa-e640-7f24-ad06-5bb9e6f434ff", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "85102589-8403-d44f-2305-1bc8ec969b15" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2017-12-18T23:49:33-05:00", "end": "2018-12-18T23:49:33-05:00" }, "created": "2017-12-18T23:49:33-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:85102589-8403-d44f-2305-1bc8ec969b15" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:8f873314-1372-8035-4cd5-65d6e2d4fc0f" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 4, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "57698-3", "display": "Lipid panel with direct LDL - Serum or Plasma" } ], "text": "Lipid panel with direct LDL - Serum or Plasma" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "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": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "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": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "informationSequence": [ 5 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "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": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "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": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "informationSequence": [ 6 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "servicedPeriod": { "start": "2017-12-18T23:11:11-05:00", "end": "2017-12-18T23:49:33-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 860.16, "currency": "USD" } } ], "payment": { "amount": { "value": 1733.376, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4", "resource": { "resourceType": "Encounter", "id": "b70af917-e83b-8f79-4d62-9245db5165f4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "b70af917-e83b-8f79-4d62-9245db5165f4" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:db68f72e-e40c-bc25-2404-546540376a8b", "resource": { "resourceType": "Condition", "id": "db68f72e-e40c-bc25-2404-546540376a8b", "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": "741062008", "display": "Not in labor force (finding)" } ], "text": "Not in labor force (finding)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "onsetDateTime": "2018-12-24T23:57:31-05:00", "abatementDateTime": "2019-12-30T23:56:04-05:00", "recordedDate": "2018-12-24T23:57:31-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:d342197a-bae8-fa58-fefc-d76d45484a0b", "resource": { "resourceType": "Observation", "id": "d342197a-bae8-fa58-fefc-d76d45484a0b", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4548-4", "display": "Hemoglobin A1c/Hemoglobin.total in Blood" } ], "text": "Hemoglobin A1c/Hemoglobin.total in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 5.86, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bbf29686-1760-9762-ad5a-ec0728a14a56", "resource": { "resourceType": "Observation", "id": "bbf29686-1760-9762-ad5a-ec0728a14a56", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 172.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bc872584-e95a-726f-eae1-b47273f2737f", "resource": { "resourceType": "Observation", "id": "bc872584-e95a-726f-eae1-b47273f2737f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0fab9eaf-f405-ba86-508e-345f1e3d5735", "resource": { "resourceType": "Observation", "id": "0fab9eaf-f405-ba86-508e-345f1e3d5735", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 81.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:94a6460f-604d-7e17-8f44-2b427246b6c2", "resource": { "resourceType": "Observation", "id": "94a6460f-604d-7e17-8f44-2b427246b6c2", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 27.19, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5d85205c-b696-c45d-e14d-53ac119c5c35", "resource": { "resourceType": "Observation", "id": "5d85205c-b696-c45d-e14d-53ac119c5c35", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 86, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 123, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e859f748-cba9-1978-c4f1-2f37630e3308", "resource": { "resourceType": "Observation", "id": "e859f748-cba9-1978-c4f1-2f37630e3308", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 83, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:df2728e1-366c-ef28-0676-c3b6d304bc8a", "resource": { "resourceType": "Observation", "id": "df2728e1-366c-ef28-0676-c3b6d304bc8a", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 15, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bcad1165-465d-ef2a-41f9-3350248a0246", "resource": { "resourceType": "Observation", "id": "bcad1165-465d-ef2a-41f9-3350248a0246", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2339-0", "display": "Glucose [Mass/volume] in Blood" } ], "text": "Glucose [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 95.99, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0f1f7983-9ffc-e0ac-b476-74cbd9ff5f33", "resource": { "resourceType": "Observation", "id": "0f1f7983-9ffc-e0ac-b476-74cbd9ff5f33", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6299-2", "display": "Urea nitrogen [Mass/volume] in Blood" } ], "text": "Urea nitrogen [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 15.24, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b7b4155c-63c8-240d-346e-17e49977ad15", "resource": { "resourceType": "Observation", "id": "b7b4155c-63c8-240d-346e-17e49977ad15", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "38483-4", "display": "Creatinine [Mass/volume] in Blood" } ], "text": "Creatinine [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 1.08, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c3158c1a-8ed2-178a-444e-0ae487bb55dd", "resource": { "resourceType": "Observation", "id": "c3158c1a-8ed2-178a-444e-0ae487bb55dd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "49765-1", "display": "Calcium [Mass/volume] in Blood" } ], "text": "Calcium [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 10.18, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:129d0fd6-961f-3476-ba80-28a17886fc97", "resource": { "resourceType": "Observation", "id": "129d0fd6-961f-3476-ba80-28a17886fc97", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2947-0", "display": "Sodium [Moles/volume] in Blood" } ], "text": "Sodium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 142.57, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9ced1e9d-4872-3cca-c3ee-31a566915086", "resource": { "resourceType": "Observation", "id": "9ced1e9d-4872-3cca-c3ee-31a566915086", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6298-4", "display": "Potassium [Moles/volume] in Blood" } ], "text": "Potassium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 5.05, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a14ec0c9-c06f-3ce0-092f-a4af9b786e8c", "resource": { "resourceType": "Observation", "id": "a14ec0c9-c06f-3ce0-092f-a4af9b786e8c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2069-3", "display": "Chloride [Moles/volume] in Blood" } ], "text": "Chloride [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 107.56, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6d73d898-e046-657b-49d8-2a61a6d974cf", "resource": { "resourceType": "Observation", "id": "6d73d898-e046-657b-49d8-2a61a6d974cf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "20565-8", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ], "text": "Carbon dioxide, total [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 25.24, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:432f4ea7-659e-ee80-9d2e-f68c31d43578", "resource": { "resourceType": "Observation", "id": "432f4ea7-659e-ee80-9d2e-f68c31d43578", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 3.721, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5484f819-0383-2c76-c088-62b1b3051002", "resource": { "resourceType": "Observation", "id": "5484f819-0383-2c76-c088-62b1b3051002", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 4.8091, "unit": "10*6/uL", "system": "http://unitsofmeasure.org", "code": "10*6/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e2aaf5dc-a1bd-b1ff-49b5-df1beef8416e", "resource": { "resourceType": "Observation", "id": "e2aaf5dc-a1bd-b1ff-49b5-df1beef8416e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 14.589, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:256503cf-81ba-57fd-15d3-b7882e38d493", "resource": { "resourceType": "Observation", "id": "256503cf-81ba-57fd-15d3-b7882e38d493", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 43.284, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b1671f9b-4543-0856-35ae-9edf7a5e926f", "resource": { "resourceType": "Observation", "id": "b1671f9b-4543-0856-35ae-9edf7a5e926f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 92.114, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b779d47b-aadc-5564-f600-acf96b8649b0", "resource": { "resourceType": "Observation", "id": "b779d47b-aadc-5564-f600-acf96b8649b0", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 28.973, "unit": "pg", "system": "http://unitsofmeasure.org", "code": "pg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d38e57bf-6e35-5905-3411-b55135df14a9", "resource": { "resourceType": "Observation", "id": "d38e57bf-6e35-5905-3411-b55135df14a9", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 33.575, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f98a7874-9148-8611-cedd-f706a9a2d2f6", "resource": { "resourceType": "Observation", "id": "f98a7874-9148-8611-cedd-f706a9a2d2f6", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 40.25, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:46601053-dc5e-8128-7d1f-e3cddf6d20b3", "resource": { "resourceType": "Observation", "id": "46601053-dc5e-8128-7d1f-e3cddf6d20b3", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 173.08, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2c13f4c3-6a16-2e14-a277-8e89b1228726", "resource": { "resourceType": "Observation", "id": "2c13f4c3-6a16-2e14-a277-8e89b1228726", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 457.11, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3f782e73-6e20-7529-10bb-8bcea31e8318", "resource": { "resourceType": "Observation", "id": "3f782e73-6e20-7529-10bb-8bcea31e8318", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueQuantity": { "value": 10.197, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bf987d8b-2e26-db57-05eb-eaaa5f3ad0eb", "resource": { "resourceType": "Observation", "id": "bf987d8b-2e26-db57-05eb-eaaa5f3ad0eb", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:296e8fcb-c1fb-2f04-a96a-f1e06d2e5eb8", "resource": { "resourceType": "Observation", "id": "296e8fcb-c1fb-2f04-a96a-f1e06d2e5eb8", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:57:31-05:00", "issued": "2018-12-24T23:57:31.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30131-9", "display": "3 to 5 times a week" } ], "text": "3 to 5 times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 417100, "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": "LA30137-6", "display": "Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)" } ], "text": "Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30193-9", "display": "More than high school" } ], "text": "More than high school" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Stroman Way" }, { "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": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 6, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:74474064-428a-62c0-b57f-5806a1d2f995", "resource": { "resourceType": "Observation", "id": "74474064-428a-62c0-b57f-5806a1d2f995", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-25T00:33:16-05:00", "issued": "2018-12-25T00:33:16.671-05:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:02f070b8-76ae-d052-7d88-07a8512f53a1", "resource": { "resourceType": "Observation", "id": "02f070b8-76ae-d052-7d88-07a8512f53a1", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-25T01:10:46-05:00", "issued": "2018-12-25T01:10:46.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4b164130-e3f6-3e2e-3e2a-61c9b77f8559", "resource": { "resourceType": "Observation", "id": "4b164130-e3f6-3e2e-3e2a-61c9b77f8559", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-25T01:43:46-05:00", "issued": "2018-12-25T01:43:46.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cfd6b883-ea32-d3a7-09f1-8167247e8e8b", "resource": { "resourceType": "Procedure", "id": "cfd6b883-ea32-d3a7-09f1-8167247e8e8b", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "performedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:26:11-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:7c13c058-c623-f2a4-e334-78688b45ae22", "resource": { "resourceType": "Procedure", "id": "7c13c058-c623-f2a4-e334-78688b45ae22", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "performedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:97186871-12ab-e9ec-7fbd-89ec4c70d3ad", "resource": { "resourceType": "Procedure", "id": "97186871-12ab-e9ec-7fbd-89ec4c70d3ad", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "performedPeriod": { "start": "2018-12-24T23:57:31-05:00", "end": "2018-12-25T00:33:16-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:479f3600-f5b9-8a50-0689-bb266f8592f3", "resource": { "resourceType": "Procedure", "id": "479f3600-f5b9-8a50-0689-bb266f8592f3", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "performedPeriod": { "start": "2018-12-25T00:33:16-05:00", "end": "2018-12-25T00:47:39-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:058813a6-3465-be7b-2814-afddcc47b201", "resource": { "resourceType": "Procedure", "id": "058813a6-3465-be7b-2814-afddcc47b201", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "performedPeriod": { "start": "2018-12-25T00:47:39-05:00", "end": "2018-12-25T01:10:46-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:8552664e-8842-7fc0-8275-06ea6c66db92", "resource": { "resourceType": "Procedure", "id": "8552664e-8842-7fc0-8275-06ea6c66db92", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "performedPeriod": { "start": "2018-12-25T01:10:46-05:00", "end": "2018-12-25T01:21:15-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:f1ae30b7-1e81-8f8b-5576-29275659a7e4", "resource": { "resourceType": "Procedure", "id": "f1ae30b7-1e81-8f8b-5576-29275659a7e4", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "performedPeriod": { "start": "2018-12-25T01:21:15-05:00", "end": "2018-12-25T01:43:46-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:cd40796a-99bc-d1a5-1f64-a3754a8c08d6", "resource": { "resourceType": "SupplyDelivery", "id": "cd40796a-99bc-d1a5-1f64-a3754a8c08d6", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2018-12-24T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:a914f542-6e22-a998-8739-3db55d884d7c", "resource": { "resourceType": "MedicationRequest", "id": "a914f542-6e22-a998-8739-3db55d884d7c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "authoredOn": "2018-12-24T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:8ce36245-c2c9-66d4-fd8f-49e8cec673f6", "resource": { "resourceType": "Claim", "id": "8ce36245-c2c9-66d4-fd8f-49e8cec673f6", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "created": "2018-12-24T23:57:31-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:a914f542-6e22-a998-8739-3db55d884d7c" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" } ] } ], "total": { "value": 0.57, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:dc8d87c4-3fcc-78ae-3f26-5b0c416a2787", "resource": { "resourceType": "ExplanationOfBenefit", "id": "dc8d87c4-3fcc-78ae-3f26-5b0c416a2787", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "8ce36245-c2c9-66d4-fd8f-49e8cec673f6" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2018-12-24T23:57:31-05:00", "end": "2019-12-24T23:57:31-05:00" }, "created": "2018-12-24T23:57:31-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:8ce36245-c2c9-66d4-fd8f-49e8cec673f6" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.57, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:bcd94379-2c48-b2f5-1e8a-984c3466c2d3", "resource": { "resourceType": "MedicationRequest", "id": "bcd94379-2c48-b2f5-1e8a-984c3466c2d3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "authoredOn": "2018-12-24T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:c86cf5b6-7d8d-60ba-4738-81ab08058195", "resource": { "resourceType": "Claim", "id": "c86cf5b6-7d8d-60ba-4738-81ab08058195", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "created": "2018-12-24T23:57:31-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:bcd94379-2c48-b2f5-1e8a-984c3466c2d3" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:edc80b67-b382-746c-b462-4b94a0f93781", "resource": { "resourceType": "ExplanationOfBenefit", "id": "edc80b67-b382-746c-b462-4b94a0f93781", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c86cf5b6-7d8d-60ba-4738-81ab08058195" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2018-12-24T23:57:31-05:00", "end": "2019-12-24T23:57:31-05:00" }, "created": "2018-12-24T23:57:31-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:c86cf5b6-7d8d-60ba-4738-81ab08058195" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:32fe1d54-6197-58c3-9cce-f9a35826ddfb", "resource": { "resourceType": "MedicationRequest", "id": "32fe1d54-6197-58c3-9cce-f9a35826ddfb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "authoredOn": "2018-12-24T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:6ea75667-2e7c-00a0-c787-adb9f96607c0", "resource": { "resourceType": "Claim", "id": "6ea75667-2e7c-00a0-c787-adb9f96607c0", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "created": "2018-12-24T23:57:31-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:32fe1d54-6197-58c3-9cce-f9a35826ddfb" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" } ] } ], "total": { "value": 1.21, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:face4c9b-b5cb-4e97-9ed1-1b7321fc9b01", "resource": { "resourceType": "ExplanationOfBenefit", "id": "face4c9b-b5cb-4e97-9ed1-1b7321fc9b01", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "6ea75667-2e7c-00a0-c787-adb9f96607c0" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2018-12-24T23:57:31-05:00", "end": "2019-12-24T23:57:31-05:00" }, "created": "2018-12-24T23:57:31-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:6ea75667-2e7c-00a0-c787-adb9f96607c0" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1.21, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:b5d95d9b-e887-33fc-70ef-2e382861a2f1", "resource": { "resourceType": "Immunization", "id": "b5d95d9b-e887-33fc-70ef-2e382861a2f1", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "occurrenceDateTime": "2018-12-24T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:145656fd-43a4-020a-f594-883322db2c9a", "resource": { "resourceType": "DiagnosticReport", "id": "145656fd-43a4-020a-f594-883322db2c9a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:bcad1165-465d-ef2a-41f9-3350248a0246", "display": "Glucose [Mass/volume] in Blood" }, { "reference": "urn:uuid:0f1f7983-9ffc-e0ac-b476-74cbd9ff5f33", "display": "Urea nitrogen [Mass/volume] in Blood" }, { "reference": "urn:uuid:b7b4155c-63c8-240d-346e-17e49977ad15", "display": "Creatinine [Mass/volume] in Blood" }, { "reference": "urn:uuid:c3158c1a-8ed2-178a-444e-0ae487bb55dd", "display": "Calcium [Mass/volume] in Blood" }, { "reference": "urn:uuid:129d0fd6-961f-3476-ba80-28a17886fc97", "display": "Sodium [Moles/volume] in Blood" }, { "reference": "urn:uuid:9ced1e9d-4872-3cca-c3ee-31a566915086", "display": "Potassium [Moles/volume] in Blood" }, { "reference": "urn:uuid:a14ec0c9-c06f-3ce0-092f-a4af9b786e8c", "display": "Chloride [Moles/volume] in Blood" }, { "reference": "urn:uuid:6d73d898-e046-657b-49d8-2a61a6d974cf", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:d091b7ec-5cd5-79cc-a980-cb21bb68e877", "resource": { "resourceType": "DiagnosticReport", "id": "d091b7ec-5cd5-79cc-a980-cb21bb68e877", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:432f4ea7-659e-ee80-9d2e-f68c31d43578", "display": "Leukocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:5484f819-0383-2c76-c088-62b1b3051002", "display": "Erythrocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:e2aaf5dc-a1bd-b1ff-49b5-df1beef8416e", "display": "Hemoglobin [Mass/volume] in Blood" }, { "reference": "urn:uuid:256503cf-81ba-57fd-15d3-b7882e38d493", "display": "Hematocrit [Volume Fraction] of Blood by Automated count" }, { "reference": "urn:uuid:b1671f9b-4543-0856-35ae-9edf7a5e926f", "display": "MCV [Entitic volume] by Automated count" }, { "reference": "urn:uuid:b779d47b-aadc-5564-f600-acf96b8649b0", "display": "MCH [Entitic mass] by Automated count" }, { "reference": "urn:uuid:d38e57bf-6e35-5905-3411-b55135df14a9", "display": "MCHC [Mass/volume] by Automated count" }, { "reference": "urn:uuid:f98a7874-9148-8611-cedd-f706a9a2d2f6", "display": "Erythrocyte distribution width [Entitic volume] by Automated count" }, { "reference": "urn:uuid:46601053-dc5e-8128-7d1f-e3cddf6d20b3", "display": "Platelets [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:2c13f4c3-6a16-2e14-a277-8e89b1228726", "display": "Platelet distribution width [Entitic volume] in Blood by Automated count" }, { "reference": "urn:uuid:3f782e73-6e20-7529-10bb-8bcea31e8318", "display": "Platelet mean volume [Entitic volume] in Blood by Automated count" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:3a00b812-205c-8583-f126-b1232e1d0de2", "resource": { "resourceType": "DiagnosticReport", "id": "3a00b812-205c-8583-f126-b1232e1d0de2", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-25T00:33:16-05:00", "issued": "2018-12-25T00:33:16.671-05:00", "result": [ { "reference": "urn:uuid:74474064-428a-62c0-b57f-5806a1d2f995", "display": "Total score [HARK]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:41057f68-c476-89d1-a107-a79af466173c", "resource": { "resourceType": "DiagnosticReport", "id": "41057f68-c476-89d1-a107-a79af466173c", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-25T01:10:46-05:00", "issued": "2018-12-25T01:10:46.671-05:00", "result": [ { "reference": "urn:uuid:02f070b8-76ae-d052-7d88-07a8512f53a1", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:df90c3c0-c9ce-ec17-b00b-03782734dd72", "resource": { "resourceType": "DiagnosticReport", "id": "df90c3c0-c9ce-ec17-b00b-03782734dd72", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-25T01:43:46-05:00", "issued": "2018-12-25T01:43:46.671-05:00", "result": [ { "reference": "urn:uuid:4b164130-e3f6-3e2e-3e2a-61c9b77f8559", "display": "Total score [AUDIT-C]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:05c41e18-d983-a78d-9f9f-0b450a2d0f9f", "resource": { "resourceType": "DiagnosticReport", "id": "05c41e18-d983-a78d-9f9f-0b450a2d0f9f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, "effectiveDateTime": "2018-12-24T23:11:11-05:00", "issued": "2018-12-24T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:e3f93e5f-9c6a-1e81-2f39-d32e73d38007", "resource": { "resourceType": "DocumentReference", "id": "e3f93e5f-9c6a-1e81-2f39-d32e73d38007", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:05c41e18-d983-a78d-9f9f-0b450a2d0f9f" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2018-12-24T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" } ], "period": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:9266aa93-d81c-6046-ccb9-f0199f1cbf4a", "resource": { "resourceType": "Claim", "id": "9266aa93-d81c-6046-ccb9-f0199f1cbf4a", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "created": "2018-12-24T23:57:31-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:b5d95d9b-e887-33fc-70ef-2e382861a2f1" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 6, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 7, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:db68f72e-e40c-bc25-2404-546540376a8b" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:cfd6b883-ea32-d3a7-09f1-8167247e8e8b" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:7c13c058-c623-f2a4-e334-78688b45ae22" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:97186871-12ab-e9ec-7fbd-89ec4c70d3ad" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:479f3600-f5b9-8a50-0689-bb266f8592f3" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:058813a6-3465-be7b-2814-afddcc47b201" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:8552664e-8842-7fc0-8275-06ea6c66db92" } }, { "sequence": 7, "procedureReference": { "reference": "urn:uuid:f1ae30b7-1e81-8f8b-5576-29275659a7e4" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" } ] }, { "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": 608.66, "currency": "USD" } }, { "sequence": 4, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "741062008", "display": "Not in labor force (finding)" } ], "text": "Not in labor force (finding)" } }, { "sequence": 9, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 13, "informationSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 14, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 15, "procedureSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 16, "informationSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 1468.82, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:9b762631-84b5-e6f6-02e1-dc4a2aeab8f7", "resource": { "resourceType": "ExplanationOfBenefit", "id": "9b762631-84b5-e6f6-02e1-dc4a2aeab8f7", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "9266aa93-d81c-6046-ccb9-f0199f1cbf4a" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2018-12-24T23:57:31-05:00", "end": "2019-12-24T23:57:31-05:00" }, "created": "2018-12-24T23:57:31-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:9266aa93-d81c-6046-ccb9-f0199f1cbf4a" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:db68f72e-e40c-bc25-2404-546540376a8b" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" } ] }, { "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": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "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": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 608.66, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 121.732, "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": 486.928, "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": 608.66, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 608.66, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "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": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "741062008", "display": "Not in labor force (finding)" } ], "text": "Not in labor force (finding)" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "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": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "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": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "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": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "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, "category": { "coding": [ { "system": "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": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 13, "informationSequence": [ 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": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 14, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 15, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 16, "informationSequence": [ 7 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "servicedPeriod": { "start": "2018-12-24T23:11:11-05:00", "end": "2018-12-24T23:57:31-05:00" }, "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": 2970.208, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23", "resource": { "resourceType": "Encounter", "id": "4041105f-555c-1224-5c10-32b5d8fe3f23", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "4041105f-555c-1224-5c10-32b5d8fe3f23" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:b3813f2b-ac4c-3585-26ab-0784bce37d52", "resource": { "resourceType": "Condition", "id": "b3813f2b-ac4c-3585-26ab-0784bce37d52", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "onsetDateTime": "2019-12-30T23:11:11-05:00", "abatementDateTime": "2019-12-30T23:11:11-05:00", "recordedDate": "2019-12-30T23:11:11-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:7c0666eb-8a17-5bc4-18c0-1901ffc52f0b", "resource": { "resourceType": "Condition", "id": "7c0666eb-8a17-5bc4-18c0-1901ffc52f0b", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "onsetDateTime": "2019-12-30T23:56:04-05:00", "abatementDateTime": "2022-01-10T23:46:44-05:00", "recordedDate": "2019-12-30T23:56:04-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:9bdd28d7-5e8c-9445-d5b8-d5bd0e4b5c43", "resource": { "resourceType": "Condition", "id": "9bdd28d7-5e8c-9445-d5b8-d5bd0e4b5c43", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "onsetDateTime": "2019-12-30T23:56:04-05:00", "abatementDateTime": "2023-01-16T23:59:31-05:00", "recordedDate": "2019-12-30T23:56:04-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:04faa266-7cbf-f3dd-79d3-4799c15a34bb", "resource": { "resourceType": "Observation", "id": "04faa266-7cbf-f3dd-79d3-4799c15a34bb", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4548-4", "display": "Hemoglobin A1c/Hemoglobin.total in Blood" } ], "text": "Hemoglobin A1c/Hemoglobin.total in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 6.11, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:dba58ad9-6a83-cce9-e932-2374451911f4", "resource": { "resourceType": "Observation", "id": "dba58ad9-6a83-cce9-e932-2374451911f4", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 172.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:112a53e8-58f9-7e88-bf8c-587cf5ab8566", "resource": { "resourceType": "Observation", "id": "112a53e8-58f9-7e88-bf8c-587cf5ab8566", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:45a2fae3-0598-bf00-4dc2-93c348987cc0", "resource": { "resourceType": "Observation", "id": "45a2fae3-0598-bf00-4dc2-93c348987cc0", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 81.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:06ef0c7b-1d13-71f0-4cb7-400525e9c340", "resource": { "resourceType": "Observation", "id": "06ef0c7b-1d13-71f0-4cb7-400525e9c340", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 27.19, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:521bc207-a5f2-4b34-9d92-66a0544480f6", "resource": { "resourceType": "Observation", "id": "521bc207-a5f2-4b34-9d92-66a0544480f6", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 87, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 133, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:750ed05b-66cd-613c-c3f5-758df8fcecb4", "resource": { "resourceType": "Observation", "id": "750ed05b-66cd-613c-c3f5-758df8fcecb4", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 64, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0589b4f4-ed12-8bfb-10c0-867d6f59d82e", "resource": { "resourceType": "Observation", "id": "0589b4f4-ed12-8bfb-10c0-867d6f59d82e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 13, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7531b37a-76d9-1939-ddad-6162d4fa7f7d", "resource": { "resourceType": "Observation", "id": "7531b37a-76d9-1939-ddad-6162d4fa7f7d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2339-0", "display": "Glucose [Mass/volume] in Blood" } ], "text": "Glucose [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 98.43, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7f1599ee-46e4-cae3-fec6-d8fc452c83a7", "resource": { "resourceType": "Observation", "id": "7f1599ee-46e4-cae3-fec6-d8fc452c83a7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6299-2", "display": "Urea nitrogen [Mass/volume] in Blood" } ], "text": "Urea nitrogen [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 17.2, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bf61a020-6ce8-0b40-a2f7-4fecc09fc680", "resource": { "resourceType": "Observation", "id": "bf61a020-6ce8-0b40-a2f7-4fecc09fc680", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "38483-4", "display": "Creatinine [Mass/volume] in Blood" } ], "text": "Creatinine [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 1.07, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b0082764-2060-5d1b-0d27-843c037e5836", "resource": { "resourceType": "Observation", "id": "b0082764-2060-5d1b-0d27-843c037e5836", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "49765-1", "display": "Calcium [Mass/volume] in Blood" } ], "text": "Calcium [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 9.86, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:47b8e2db-94af-98b5-58b0-bb36eba7ff5d", "resource": { "resourceType": "Observation", "id": "47b8e2db-94af-98b5-58b0-bb36eba7ff5d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2947-0", "display": "Sodium [Moles/volume] in Blood" } ], "text": "Sodium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 142.01, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c7ebbff8-5257-83fd-6a6b-47940995ae47", "resource": { "resourceType": "Observation", "id": "c7ebbff8-5257-83fd-6a6b-47940995ae47", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6298-4", "display": "Potassium [Moles/volume] in Blood" } ], "text": "Potassium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 5.06, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ca93533e-965a-39fe-209c-cdd8de6e7999", "resource": { "resourceType": "Observation", "id": "ca93533e-965a-39fe-209c-cdd8de6e7999", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2069-3", "display": "Chloride [Moles/volume] in Blood" } ], "text": "Chloride [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 102.4, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2f02cd4e-21f5-1598-2a5b-eafdf05ce41a", "resource": { "resourceType": "Observation", "id": "2f02cd4e-21f5-1598-2a5b-eafdf05ce41a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "20565-8", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ], "text": "Carbon dioxide, total [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueQuantity": { "value": 20.62, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:69381c91-1a2e-df2f-6e37-2f972225c443", "resource": { "resourceType": "Observation", "id": "69381c91-1a2e-df2f-6e37-2f972225c443", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:17a8b294-bdd2-e31d-59ce-c84ce514da05", "resource": { "resourceType": "Observation", "id": "17a8b294-bdd2-e31d-59ce-c84ce514da05", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:56:04-05:00", "issued": "2019-12-30T23:56:04.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA13863-8", "display": "A little bit" } ], "text": "A little bit" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30132-7", "display": "5 or more times a week" } ], "text": "5 or more times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 417100, "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": "LA30193-9", "display": "More than high school" } ], "text": "More than high school" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Stroman Way" }, { "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": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 6, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:61a50124-5509-c3b3-d9fb-febbafb8c380", "resource": { "resourceType": "Observation", "id": "61a50124-5509-c3b3-d9fb-febbafb8c380", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-31T00:38:42-05:00", "issued": "2019-12-31T00:38:42.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6d72f0cb-a9bb-bc55-2b85-51007dc23816", "resource": { "resourceType": "Observation", "id": "6d72f0cb-a9bb-bc55-2b85-51007dc23816", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-31T01:17:09-05:00", "issued": "2019-12-31T01:17:09.671-05:00", "valueQuantity": { "value": 2, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b9b7ed79-7695-21fb-65f0-b92412d273f3", "resource": { "resourceType": "Procedure", "id": "b9b7ed79-7695-21fb-65f0-b92412d273f3", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "performedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:26:11-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:f919801c-952b-ffdf-394b-367b2a1d0a29", "resource": { "resourceType": "Procedure", "id": "f919801c-952b-ffdf-394b-367b2a1d0a29", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "performedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b1d56d63-4eae-570d-85e2-9d5068efb537", "resource": { "resourceType": "Procedure", "id": "b1d56d63-4eae-570d-85e2-9d5068efb537", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "performedPeriod": { "start": "2019-12-30T23:56:04-05:00", "end": "2019-12-31T00:09:07-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:8345370d-6a26-e32d-f42a-beae3d085d7b", "resource": { "resourceType": "Procedure", "id": "8345370d-6a26-e32d-f42a-beae3d085d7b", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "performedPeriod": { "start": "2019-12-31T00:09:07-05:00", "end": "2019-12-31T00:38:42-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1fe845c8-0004-d9d0-0cd1-987d715bde8c", "resource": { "resourceType": "Procedure", "id": "1fe845c8-0004-d9d0-0cd1-987d715bde8c", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "performedPeriod": { "start": "2019-12-31T00:38:42-05:00", "end": "2019-12-31T00:50:43-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:5516be19-afbd-e16a-7a80-a27f40f1c59d", "resource": { "resourceType": "Procedure", "id": "5516be19-afbd-e16a-7a80-a27f40f1c59d", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "performedPeriod": { "start": "2019-12-31T00:50:43-05:00", "end": "2019-12-31T01:17:09-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:18ff14c5-1a57-7868-e781-45dc0bf661ec", "resource": { "resourceType": "SupplyDelivery", "id": "18ff14c5-1a57-7868-e781-45dc0bf661ec", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2019-12-30T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:d8e9e6a3-c3c7-512a-7522-28b0b734a7f5", "resource": { "resourceType": "MedicationRequest", "id": "d8e9e6a3-c3c7-512a-7522-28b0b734a7f5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "authoredOn": "2019-12-30T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:1c879349-d9b6-0106-e456-cf346f8a7a79", "resource": { "resourceType": "Claim", "id": "1c879349-d9b6-0106-e456-cf346f8a7a79", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "created": "2019-12-30T23:56:04-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:d8e9e6a3-c3c7-512a-7522-28b0b734a7f5" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" } ] } ], "total": { "value": 0.50, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:42ed70c2-fe4b-04a6-f3ee-57242e564003", "resource": { "resourceType": "ExplanationOfBenefit", "id": "42ed70c2-fe4b-04a6-f3ee-57242e564003", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "1c879349-d9b6-0106-e456-cf346f8a7a79" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2019-12-30T23:56:04-05:00", "end": "2020-12-30T23:56:04-05:00" }, "created": "2019-12-30T23:56:04-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:1c879349-d9b6-0106-e456-cf346f8a7a79" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.50, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:6130af7e-4bcc-45bf-e8f2-2254883b2188", "resource": { "resourceType": "MedicationRequest", "id": "6130af7e-4bcc-45bf-e8f2-2254883b2188", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "authoredOn": "2019-12-30T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:177462d3-ec8a-4760-1326-fb7e4ca2cfa8", "resource": { "resourceType": "Claim", "id": "177462d3-ec8a-4760-1326-fb7e4ca2cfa8", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "created": "2019-12-30T23:56:04-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:6130af7e-4bcc-45bf-e8f2-2254883b2188" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e5c903e0-33c0-dac6-ef49-5dbb2148e1f9", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e5c903e0-33c0-dac6-ef49-5dbb2148e1f9", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "177462d3-ec8a-4760-1326-fb7e4ca2cfa8" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2019-12-30T23:56:04-05:00", "end": "2020-12-30T23:56:04-05:00" }, "created": "2019-12-30T23:56:04-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:177462d3-ec8a-4760-1326-fb7e4ca2cfa8" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:b1dceea6-e4a7-f699-9944-490844ad92f4", "resource": { "resourceType": "MedicationRequest", "id": "b1dceea6-e4a7-f699-9944-490844ad92f4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "authoredOn": "2019-12-30T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:41483aaf-9215-68e8-b264-9a22ca5bbeec", "resource": { "resourceType": "Claim", "id": "41483aaf-9215-68e8-b264-9a22ca5bbeec", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "created": "2019-12-30T23:56:04-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:b1dceea6-e4a7-f699-9944-490844ad92f4" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" } ] } ], "total": { "value": 1.06, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:05294d19-d57c-59fd-5f04-3aa1dcaf637d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "05294d19-d57c-59fd-5f04-3aa1dcaf637d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "41483aaf-9215-68e8-b264-9a22ca5bbeec" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2019-12-30T23:56:04-05:00", "end": "2020-12-30T23:56:04-05:00" }, "created": "2019-12-30T23:56:04-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:41483aaf-9215-68e8-b264-9a22ca5bbeec" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1.06, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d025fdee-caa3-63d7-c6bc-236eb52bb4fc", "resource": { "resourceType": "Immunization", "id": "d025fdee-caa3-63d7-c6bc-236eb52bb4fc", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "occurrenceDateTime": "2019-12-30T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:23cfbc21-6613-1372-3035-21505fcc93ce", "resource": { "resourceType": "DiagnosticReport", "id": "23cfbc21-6613-1372-3035-21505fcc93ce", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:7531b37a-76d9-1939-ddad-6162d4fa7f7d", "display": "Glucose [Mass/volume] in Blood" }, { "reference": "urn:uuid:7f1599ee-46e4-cae3-fec6-d8fc452c83a7", "display": "Urea nitrogen [Mass/volume] in Blood" }, { "reference": "urn:uuid:bf61a020-6ce8-0b40-a2f7-4fecc09fc680", "display": "Creatinine [Mass/volume] in Blood" }, { "reference": "urn:uuid:b0082764-2060-5d1b-0d27-843c037e5836", "display": "Calcium [Mass/volume] in Blood" }, { "reference": "urn:uuid:47b8e2db-94af-98b5-58b0-bb36eba7ff5d", "display": "Sodium [Moles/volume] in Blood" }, { "reference": "urn:uuid:c7ebbff8-5257-83fd-6a6b-47940995ae47", "display": "Potassium [Moles/volume] in Blood" }, { "reference": "urn:uuid:ca93533e-965a-39fe-209c-cdd8de6e7999", "display": "Chloride [Moles/volume] in Blood" }, { "reference": "urn:uuid:2f02cd4e-21f5-1598-2a5b-eafdf05ce41a", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:ca56dab3-8857-b83e-7418-25004cc9c43d", "resource": { "resourceType": "DiagnosticReport", "id": "ca56dab3-8857-b83e-7418-25004cc9c43d", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-31T00:38:42-05:00", "issued": "2019-12-31T00:38:42.671-05:00", "result": [ { "reference": "urn:uuid:61a50124-5509-c3b3-d9fb-febbafb8c380", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:081877d5-e9df-fbff-9927-8a8943f145ff", "resource": { "resourceType": "DiagnosticReport", "id": "081877d5-e9df-fbff-9927-8a8943f145ff", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-31T01:17:09-05:00", "issued": "2019-12-31T01:17:09.671-05:00", "result": [ { "reference": "urn:uuid:6d72f0cb-a9bb-bc55-2b85-51007dc23816", "display": "Total score [DAST-10]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1284c2de-cf83-5f3f-ed71-ef0f78eb7198", "resource": { "resourceType": "DiagnosticReport", "id": "1284c2de-cf83-5f3f-ed71-ef0f78eb7198", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, "effectiveDateTime": "2019-12-30T23:11:11-05:00", "issued": "2019-12-30T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:d7ce498a-5cce-ac42-1863-1861c630318e", "resource": { "resourceType": "DocumentReference", "id": "d7ce498a-5cce-ac42-1863-1861c630318e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:1284c2de-cf83-5f3f-ed71-ef0f78eb7198" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2019-12-30T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" } ], "period": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:2014bc36-e4e3-75bc-9b61-b1918ef63dc1", "resource": { "resourceType": "Claim", "id": "2014bc36-e4e3-75bc-9b61-b1918ef63dc1", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "created": "2019-12-30T23:56:04-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:d025fdee-caa3-63d7-c6bc-236eb52bb4fc" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:b3813f2b-ac4c-3585-26ab-0784bce37d52" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:7c0666eb-8a17-5bc4-18c0-1901ffc52f0b" } }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:9bdd28d7-5e8c-9445-d5b8-d5bd0e4b5c43" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:b9b7ed79-7695-21fb-65f0-b92412d273f3" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:f919801c-952b-ffdf-394b-367b2a1d0a29" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:b1d56d63-4eae-570d-85e2-9d5068efb537" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:8345370d-6a26-e32d-f42a-beae3d085d7b" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:1fe845c8-0004-d9d0-0cd1-987d715bde8c" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:5516be19-afbd-e16a-7a80-a27f40f1c59d" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" } ] }, { "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, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 479.29, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" } }, { "sequence": 9, "diagnosisSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" } }, { "sequence": 10, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 13, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 14, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 15, "informationSequence": [ 5 ], "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": 1264.87, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:93a394dd-fa6d-c09c-2ba5-328cd2ee33cd", "resource": { "resourceType": "ExplanationOfBenefit", "id": "93a394dd-fa6d-c09c-2ba5-328cd2ee33cd", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "2014bc36-e4e3-75bc-9b61-b1918ef63dc1" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2019-12-30T23:56:04-05:00", "end": "2020-12-30T23:56:04-05:00" }, "created": "2019-12-30T23:56:04-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:2014bc36-e4e3-75bc-9b61-b1918ef63dc1" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:b3813f2b-ac4c-3585-26ab-0784bce37d52" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:7c0666eb-8a17-5bc4-18c0-1901ffc52f0b" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:9bdd28d7-5e8c-9445-d5b8-d5bd0e4b5c43" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "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": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "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": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 479.29, "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": 95.858, "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": 383.432, "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": 479.29, "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": 479.29, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "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": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 9, "diagnosisSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "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": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 13, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 14, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "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": [ 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": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "servicedPeriod": { "start": "2019-12-30T23:11:11-05:00", "end": "2019-12-30T23:56:04-05:00" }, "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": 1264.87, "currency": "USD" } } ], "payment": { "amount": { "value": 2402.264, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782", "resource": { "resourceType": "Encounter", "id": "e61d8353-a100-43d8-34f9-b5de7f835782", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "e61d8353-a100-43d8-34f9-b5de7f835782" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:f985b32b-fbce-ca8d-7541-c8fa86881396", "resource": { "resourceType": "Condition", "id": "f985b32b-fbce-ca8d-7541-c8fa86881396", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "onsetDateTime": "2021-01-04T23:11:11-05:00", "abatementDateTime": "2022-01-10T23:11:11-05:00", "recordedDate": "2021-01-04T23:11:11-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:0fcf2e53-9a00-5722-5b60-2897f8d02022", "resource": { "resourceType": "Observation", "id": "0fcf2e53-9a00-5722-5b60-2897f8d02022", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4548-4", "display": "Hemoglobin A1c/Hemoglobin.total in Blood" } ], "text": "Hemoglobin A1c/Hemoglobin.total in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 6.14, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7742726b-3f3d-a826-f684-edf2741dbc7c", "resource": { "resourceType": "Observation", "id": "7742726b-3f3d-a826-f684-edf2741dbc7c", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 172.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:16570ce9-6680-66bf-9610-b07e755c6fb3", "resource": { "resourceType": "Observation", "id": "16570ce9-6680-66bf-9610-b07e755c6fb3", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 3, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:fbf07f23-3de6-8c40-6fcb-06e24671824b", "resource": { "resourceType": "Observation", "id": "fbf07f23-3de6-8c40-6fcb-06e24671824b", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 81.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9473987b-ee4e-5edc-0bbe-0dc49b723014", "resource": { "resourceType": "Observation", "id": "9473987b-ee4e-5edc-0bbe-0dc49b723014", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 27.19, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b0835835-6a40-07c9-0c8c-4d11d477fcdc", "resource": { "resourceType": "Observation", "id": "b0835835-6a40-07c9-0c8c-4d11d477fcdc", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 93, "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": 130, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a9b8edeb-dac6-3bb5-6d07-7683838fc539", "resource": { "resourceType": "Observation", "id": "a9b8edeb-dac6-3bb5-6d07-7683838fc539", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 94, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0265d71e-5152-78af-bd72-871048ba3f55", "resource": { "resourceType": "Observation", "id": "0265d71e-5152-78af-bd72-871048ba3f55", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 14, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c686eebc-e6f2-9284-be6f-5c3801331f87", "resource": { "resourceType": "Observation", "id": "c686eebc-e6f2-9284-be6f-5c3801331f87", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2339-0", "display": "Glucose [Mass/volume] in Blood" } ], "text": "Glucose [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 84.76, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e1902ea8-fcb0-ccd7-23f7-2bdb13a25863", "resource": { "resourceType": "Observation", "id": "e1902ea8-fcb0-ccd7-23f7-2bdb13a25863", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6299-2", "display": "Urea nitrogen [Mass/volume] in Blood" } ], "text": "Urea nitrogen [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 11.86, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:659b24cb-b82f-e589-e38f-e1f9637c17f6", "resource": { "resourceType": "Observation", "id": "659b24cb-b82f-e589-e38f-e1f9637c17f6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "38483-4", "display": "Creatinine [Mass/volume] in Blood" } ], "text": "Creatinine [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 1.28, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a219317c-c308-c0cc-7274-d4405cc165b8", "resource": { "resourceType": "Observation", "id": "a219317c-c308-c0cc-7274-d4405cc165b8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "49765-1", "display": "Calcium [Mass/volume] in Blood" } ], "text": "Calcium [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 8.82, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:673cbccc-85ef-95e5-9752-e97d437f26ee", "resource": { "resourceType": "Observation", "id": "673cbccc-85ef-95e5-9752-e97d437f26ee", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2947-0", "display": "Sodium [Moles/volume] in Blood" } ], "text": "Sodium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 141.38, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c12fed1f-af78-a434-de5b-444edb0e854f", "resource": { "resourceType": "Observation", "id": "c12fed1f-af78-a434-de5b-444edb0e854f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6298-4", "display": "Potassium [Moles/volume] in Blood" } ], "text": "Potassium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 3.9, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e1e7b2ff-1f04-b471-3ec9-651d47a29bea", "resource": { "resourceType": "Observation", "id": "e1e7b2ff-1f04-b471-3ec9-651d47a29bea", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2069-3", "display": "Chloride [Moles/volume] in Blood" } ], "text": "Chloride [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 105.54, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8dfb3e2d-161d-ea38-2154-f7494f098e46", "resource": { "resourceType": "Observation", "id": "8dfb3e2d-161d-ea38-2154-f7494f098e46", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "20565-8", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ], "text": "Carbon dioxide, total [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 24.94, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ac151ed0-491c-9604-3eeb-5224bd03915f", "resource": { "resourceType": "Observation", "id": "ac151ed0-491c-9604-3eeb-5224bd03915f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 156.58, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:fc4d3f1b-d049-eac5-5fd5-acd6533f4353", "resource": { "resourceType": "Observation", "id": "fc4d3f1b-d049-eac5-5fd5-acd6533f4353", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 102.83, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:53b1454b-b977-b74c-c68e-a60f0ac6e980", "resource": { "resourceType": "Observation", "id": "53b1454b-b977-b74c-c68e-a60f0ac6e980", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 103.59, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5308d529-ac05-bd10-c90d-e7e48a290bad", "resource": { "resourceType": "Observation", "id": "5308d529-ac05-bd10-c90d-e7e48a290bad", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueQuantity": { "value": 32.42, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3a5e26af-af5a-0b8e-0044-99f9c6f026e3", "resource": { "resourceType": "Observation", "id": "3a5e26af-af5a-0b8e-0044-99f9c6f026e3", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8313f3ab-ab7c-6e28-8654-aa78760b3eaf", "resource": { "resourceType": "Observation", "id": "8313f3ab-ab7c-6e28-8654-aa78760b3eaf", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:54:47-05:00", "issued": "2021-01-04T23:54:47.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA13909-9", "display": "Somewhat" } ], "text": "Somewhat" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30131-9", "display": "3 to 5 times a week" } ], "text": "3 to 5 times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "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": 417100, "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": "LA30193-9", "display": "More than high school" } ], "text": "More than high school" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Stroman Way" }, { "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": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 6, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:87b724ef-f1f1-e95c-dde4-3750a4f34885", "resource": { "resourceType": "Observation", "id": "87b724ef-f1f1-e95c-dde4-3750a4f34885", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-05T00:36:58-05:00", "issued": "2021-01-05T00:36:58.671-05:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:192c0ac8-220c-e4fb-2d8a-fb2ab704bf41", "resource": { "resourceType": "Observation", "id": "192c0ac8-220c-e4fb-2d8a-fb2ab704bf41", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-05T01:15:33-05:00", "issued": "2021-01-05T01:15:33.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c1e6d036-1145-32a1-c0ba-d9b60b0eca27", "resource": { "resourceType": "Procedure", "id": "c1e6d036-1145-32a1-c0ba-d9b60b0eca27", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "performedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:62758dd7-6da7-3911-0de0-79f403be5113", "resource": { "resourceType": "Procedure", "id": "62758dd7-6da7-3911-0de0-79f403be5113", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "performedPeriod": { "start": "2021-01-04T23:54:47-05:00", "end": "2021-01-05T00:36:58-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:6a593244-0118-c7c4-94d9-6f8ca05c5bec", "resource": { "resourceType": "Procedure", "id": "6a593244-0118-c7c4-94d9-6f8ca05c5bec", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "performedPeriod": { "start": "2021-01-05T00:36:58-05:00", "end": "2021-01-05T00:50:25-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:c02427d5-2456-a73c-0a74-83a7d09082cb", "resource": { "resourceType": "Procedure", "id": "c02427d5-2456-a73c-0a74-83a7d09082cb", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "performedPeriod": { "start": "2021-01-05T00:50:25-05:00", "end": "2021-01-05T01:15:33-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:4efec9a2-09e3-ffe9-cfb4-b1fa25ac9734", "resource": { "resourceType": "SupplyDelivery", "id": "4efec9a2-09e3-ffe9-cfb4-b1fa25ac9734", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2021-01-04T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:5e05f0c6-a056-8f8d-3353-d20a4ce505cf", "resource": { "resourceType": "MedicationRequest", "id": "5e05f0c6-a056-8f8d-3353-d20a4ce505cf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "authoredOn": "2021-01-04T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:40cc8740-c03b-dd39-eadc-fb269716537f", "resource": { "resourceType": "Claim", "id": "40cc8740-c03b-dd39-eadc-fb269716537f", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "created": "2021-01-04T23:54:47-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:5e05f0c6-a056-8f8d-3353-d20a4ce505cf" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" } ] } ], "total": { "value": 0.48, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:199a365f-8121-ef83-6728-1e611ed0c821", "resource": { "resourceType": "ExplanationOfBenefit", "id": "199a365f-8121-ef83-6728-1e611ed0c821", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "40cc8740-c03b-dd39-eadc-fb269716537f" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2021-01-04T23:54:47-05:00", "end": "2022-01-04T23:54:47-05:00" }, "created": "2021-01-04T23:54:47-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:40cc8740-c03b-dd39-eadc-fb269716537f" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.48, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a2a1ce9e-61d9-b907-a959-1268aeb1957d", "resource": { "resourceType": "MedicationRequest", "id": "a2a1ce9e-61d9-b907-a959-1268aeb1957d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "authoredOn": "2021-01-04T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:65dce252-b788-c5af-d064-219c7937931b", "resource": { "resourceType": "Claim", "id": "65dce252-b788-c5af-d064-219c7937931b", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "created": "2021-01-04T23:54:47-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:a2a1ce9e-61d9-b907-a959-1268aeb1957d" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:ee2da33e-8c21-1efe-c91b-2d2364ff9f18", "resource": { "resourceType": "ExplanationOfBenefit", "id": "ee2da33e-8c21-1efe-c91b-2d2364ff9f18", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "65dce252-b788-c5af-d064-219c7937931b" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2021-01-04T23:54:47-05:00", "end": "2022-01-04T23:54:47-05:00" }, "created": "2021-01-04T23:54:47-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:65dce252-b788-c5af-d064-219c7937931b" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:5671c01f-7b74-48bb-5932-68723ae84f0d", "resource": { "resourceType": "MedicationRequest", "id": "5671c01f-7b74-48bb-5932-68723ae84f0d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "authoredOn": "2021-01-04T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:cb005a49-5ccd-29c3-54ae-4cabc3ec2555", "resource": { "resourceType": "Claim", "id": "cb005a49-5ccd-29c3-54ae-4cabc3ec2555", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "created": "2021-01-04T23:54:47-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:5671c01f-7b74-48bb-5932-68723ae84f0d" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" } ] } ], "total": { "value": 1.21, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:d5e1e25f-7eb3-0dbc-236f-ca611c61e65b", "resource": { "resourceType": "ExplanationOfBenefit", "id": "d5e1e25f-7eb3-0dbc-236f-ca611c61e65b", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "cb005a49-5ccd-29c3-54ae-4cabc3ec2555" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2021-01-04T23:54:47-05:00", "end": "2022-01-04T23:54:47-05:00" }, "created": "2021-01-04T23:54:47-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:cb005a49-5ccd-29c3-54ae-4cabc3ec2555" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1.21, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f34a6a6a-d81c-bcd8-8d14-bceca4b23a25", "resource": { "resourceType": "Immunization", "id": "f34a6a6a-d81c-bcd8-8d14-bceca4b23a25", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "occurrenceDateTime": "2021-01-04T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:b6d52ff7-5011-a9c6-79d6-bda503456dca", "resource": { "resourceType": "DiagnosticReport", "id": "b6d52ff7-5011-a9c6-79d6-bda503456dca", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:c686eebc-e6f2-9284-be6f-5c3801331f87", "display": "Glucose [Mass/volume] in Blood" }, { "reference": "urn:uuid:e1902ea8-fcb0-ccd7-23f7-2bdb13a25863", "display": "Urea nitrogen [Mass/volume] in Blood" }, { "reference": "urn:uuid:659b24cb-b82f-e589-e38f-e1f9637c17f6", "display": "Creatinine [Mass/volume] in Blood" }, { "reference": "urn:uuid:a219317c-c308-c0cc-7274-d4405cc165b8", "display": "Calcium [Mass/volume] in Blood" }, { "reference": "urn:uuid:673cbccc-85ef-95e5-9752-e97d437f26ee", "display": "Sodium [Moles/volume] in Blood" }, { "reference": "urn:uuid:c12fed1f-af78-a434-de5b-444edb0e854f", "display": "Potassium [Moles/volume] in Blood" }, { "reference": "urn:uuid:e1e7b2ff-1f04-b471-3ec9-651d47a29bea", "display": "Chloride [Moles/volume] in Blood" }, { "reference": "urn:uuid:8dfb3e2d-161d-ea38-2154-f7494f098e46", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:fb891275-26cc-f6c2-2cac-02e29700dc33", "resource": { "resourceType": "DiagnosticReport", "id": "fb891275-26cc-f6c2-2cac-02e29700dc33", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:ac151ed0-491c-9604-3eeb-5224bd03915f", "display": "Cholesterol [Mass/volume] in Serum or Plasma" }, { "reference": "urn:uuid:fc4d3f1b-d049-eac5-5fd5-acd6533f4353", "display": "Triglycerides" }, { "reference": "urn:uuid:53b1454b-b977-b74c-c68e-a60f0ac6e980", "display": "Low Density Lipoprotein Cholesterol" }, { "reference": "urn:uuid:5308d529-ac05-bd10-c90d-e7e48a290bad", "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:dae77ee1-543d-a417-3d7d-614c8b86f45a", "resource": { "resourceType": "DiagnosticReport", "id": "dae77ee1-543d-a417-3d7d-614c8b86f45a", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-05T00:36:58-05:00", "issued": "2021-01-05T00:36:58.671-05:00", "result": [ { "reference": "urn:uuid:87b724ef-f1f1-e95c-dde4-3750a4f34885", "display": "Total score [HARK]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:dff71cca-afb0-3359-b801-b77285827b19", "resource": { "resourceType": "DiagnosticReport", "id": "dff71cca-afb0-3359-b801-b77285827b19", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-05T01:15:33-05:00", "issued": "2021-01-05T01:15:33.671-05:00", "result": [ { "reference": "urn:uuid:192c0ac8-220c-e4fb-2d8a-fb2ab704bf41", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:94f1d563-78f2-4cd6-9f88-568916a11f99", "resource": { "resourceType": "DiagnosticReport", "id": "94f1d563-78f2-4cd6-9f88-568916a11f99", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, "effectiveDateTime": "2021-01-04T23:11:11-05:00", "issued": "2021-01-04T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:5dd23003-fa78-6918-d468-4858ae81b605", "resource": { "resourceType": "DocumentReference", "id": "5dd23003-fa78-6918-d468-4858ae81b605", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:94f1d563-78f2-4cd6-9f88-568916a11f99" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2021-01-04T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" } ], "period": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:08481091-1386-f908-a008-429f5890b08d", "resource": { "resourceType": "Claim", "id": "08481091-1386-f908-a008-429f5890b08d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "created": "2021-01-04T23:54:47-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:f34a6a6a-d81c-bcd8-8d14-bceca4b23a25" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 6, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:f985b32b-fbce-ca8d-7541-c8fa86881396" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:c1e6d036-1145-32a1-c0ba-d9b60b0eca27" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:62758dd7-6da7-3911-0de0-79f403be5113" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:6a593244-0118-c7c4-94d9-6f8ca05c5bec" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:c02427d5-2456-a73c-0a74-83a7d09082cb" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 4, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "net": { "value": 74.58, "currency": "USD" } }, { "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": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "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": 10, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "informationSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 860.16, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:d17d17c7-c823-8b78-aa1b-6555b0252927", "resource": { "resourceType": "ExplanationOfBenefit", "id": "d17d17c7-c823-8b78-aa1b-6555b0252927", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "08481091-1386-f908-a008-429f5890b08d" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2021-01-04T23:54:47-05:00", "end": "2022-01-04T23:54:47-05:00" }, "created": "2021-01-04T23:54:47-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:08481091-1386-f908-a008-429f5890b08d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:f985b32b-fbce-ca8d-7541-c8fa86881396" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "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": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 4, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "57698-3", "display": "Lipid panel with direct LDL - Serum or Plasma" } ], "text": "Lipid panel with direct LDL - Serum or Plasma" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "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": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "informationSequence": [ 5 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "informationSequence": [ 6 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2021-01-04T23:11:11-05:00", "end": "2021-01-04T23:54:47-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 860.16, "currency": "USD" } } ], "payment": { "amount": { "value": 1733.376, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:00672ec7-bd8d-213a-1ebd-9f29b4926976", "resource": { "resourceType": "Encounter", "id": "00672ec7-bd8d-213a-1ebd-9f29b4926976", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "00672ec7-bd8d-213a-1ebd-9f29b4926976" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-10-19T00:11:11-04:00", "end": "2021-10-19T00:26:11-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } } ], "period": { "start": "2021-10-19T00:11:11-04:00", "end": "2021-10-19T00:26:11-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:3ed8418e-f903-a96f-7a07-28f30e089c21", "resource": { "resourceType": "Immunization", "id": "3ed8418e-f903-a96f-7a07-28f30e089c21", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:00672ec7-bd8d-213a-1ebd-9f29b4926976" }, "occurrenceDateTime": "2021-10-19T00:11:11-04:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:c639034c-6020-6281-2e4b-9d274d4c932b", "resource": { "resourceType": "DiagnosticReport", "id": "c639034c-6020-6281-2e4b-9d274d4c932b", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:00672ec7-bd8d-213a-1ebd-9f29b4926976" }, "effectiveDateTime": "2021-10-19T00:11:11-04:00", "issued": "2021-10-19T00:11:11.671-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:66c9d4ee-9e64-f8aa-c84f-202f3333d013", "resource": { "resourceType": "DocumentReference", "id": "66c9d4ee-9e64-f8aa-c84f-202f3333d013", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:c639034c-6020-6281-2e4b-9d274d4c932b" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2021-10-19T00:11:11.671-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "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:00672ec7-bd8d-213a-1ebd-9f29b4926976" } ], "period": { "start": "2021-10-19T00:11:11-04:00", "end": "2021-10-19T00:26:11-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:fae6674c-92b8-2e27-8b12-454e928104e7", "resource": { "resourceType": "Claim", "id": "fae6674c-92b8-2e27-8b12-454e928104e7", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2021-10-19T00:11:11-04:00", "end": "2021-10-19T00:26:11-04:00" }, "created": "2021-10-19T00:26:11-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:3ed8418e-f903-a96f-7a07-28f30e089c21" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "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:00672ec7-bd8d-213a-1ebd-9f29b4926976" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "net": { "value": 136.00, "currency": "USD" } } ], "total": { "value": 278.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:9aede761-8593-f9f6-0259-9d8edef897f7", "resource": { "resourceType": "ExplanationOfBenefit", "id": "9aede761-8593-f9f6-0259-9d8edef897f7", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "fae6674c-92b8-2e27-8b12-454e928104e7" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2021-10-19T00:26:11-04:00", "end": "2022-10-19T00:26:11-04:00" }, "created": "2021-10-19T00:26:11-04:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "claim": { "reference": "urn:uuid:fae6674c-92b8-2e27-8b12-454e928104e7" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "33879002", "display": "Administration of vaccine to produce active immunity (procedure)" } ], "text": "Administration of vaccine to produce active immunity (procedure)" }, "servicedPeriod": { "start": "2021-10-19T00:11:11-04:00", "end": "2021-10-19T00:26:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:00672ec7-bd8d-213a-1ebd-9f29b4926976" } ] }, { "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": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "servicedPeriod": { "start": "2021-10-19T00:11:11-04:00", "end": "2021-10-19T00:26:11-04:00" }, "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:b7116f85-a51a-087f-df00-1ec3fe675960", "resource": { "resourceType": "Encounter", "id": "b7116f85-a51a-087f-df00-1ec3fe675960", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "b7116f85-a51a-087f-df00-1ec3fe675960" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-11-08T23:11:11-05:00", "end": "2021-11-08T23:26:11-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } } ], "period": { "start": "2021-11-08T23:11:11-05:00", "end": "2021-11-08T23:26:11-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:c8d1a932-ee3f-cc54-f3a2-1d19570087f1", "resource": { "resourceType": "Immunization", "id": "c8d1a932-ee3f-cc54-f3a2-1d19570087f1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b7116f85-a51a-087f-df00-1ec3fe675960" }, "occurrenceDateTime": "2021-11-08T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:89cc4a74-97fe-64b5-ca61-194c015fea00", "resource": { "resourceType": "DiagnosticReport", "id": "89cc4a74-97fe-64b5-ca61-194c015fea00", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:b7116f85-a51a-087f-df00-1ec3fe675960" }, "effectiveDateTime": "2021-11-08T23:11:11-05:00", "issued": "2021-11-08T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:30d3e235-1d25-8134-3cfe-3c39b39c3c7f", "resource": { "resourceType": "DocumentReference", "id": "30d3e235-1d25-8134-3cfe-3c39b39c3c7f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:89cc4a74-97fe-64b5-ca61-194c015fea00" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2021-11-08T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392", "display": "Dr. Araceli695 Willms744" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "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:b7116f85-a51a-087f-df00-1ec3fe675960" } ], "period": { "start": "2021-11-08T23:11:11-05:00", "end": "2021-11-08T23:26:11-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:bfce9270-56aa-925b-ca43-5e20c85b4760", "resource": { "resourceType": "Claim", "id": "bfce9270-56aa-925b-ca43-5e20c85b4760", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2021-11-08T23:11:11-05:00", "end": "2021-11-08T23:26:11-05:00" }, "created": "2021-11-08T23:26:11-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|352f2e3b-0708-3eb4-9f7e-e73a685bf379", "display": "MARLBOROUGH HOSPITAL CORP" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:c8d1a932-ee3f-cc54-f3a2-1d19570087f1" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "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:b7116f85-a51a-087f-df00-1ec3fe675960" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "net": { "value": 136.00, "currency": "USD" } } ], "total": { "value": 278.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:b9dcb665-9c62-be97-1567-cab99f319604", "resource": { "resourceType": "ExplanationOfBenefit", "id": "b9dcb665-9c62-be97-1567-cab99f319604", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "bfce9270-56aa-925b-ca43-5e20c85b4760" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2021-11-08T23:26:11-05:00", "end": "2022-11-08T23:26:11-05:00" }, "created": "2021-11-08T23:26:11-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fde1651a-f8c8-3368-9965-bdafb0249d73", "display": "MARLBOROUGH HOSPITAL CORP" }, "claim": { "reference": "urn:uuid:bfce9270-56aa-925b-ca43-5e20c85b4760" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994392" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "33879002", "display": "Administration of vaccine to produce active immunity (procedure)" } ], "text": "Administration of vaccine to produce active immunity (procedure)" }, "servicedPeriod": { "start": "2021-11-08T23:11:11-05:00", "end": "2021-11-08T23:26:11-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b7116f85-a51a-087f-df00-1ec3fe675960" } ] }, { "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": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "servicedPeriod": { "start": "2021-11-08T23:11:11-05:00", "end": "2021-11-08T23:26:11-05:00" }, "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:99396b50-da30-c8a7-7d10-b6d3efb457ed", "resource": { "resourceType": "Encounter", "id": "99396b50-da30-c8a7-7d10-b6d3efb457ed", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "99396b50-da30-c8a7-7d10-b6d3efb457ed" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:b35f5f32-733d-c7a5-96f7-08f145aea8a3", "resource": { "resourceType": "Condition", "id": "b35f5f32-733d-c7a5-96f7-08f145aea8a3", "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": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "onsetDateTime": "2022-01-10T23:46:44-05:00", "recordedDate": "2022-01-10T23:46:44-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:8eed5019-e3e7-4d53-b280-e56266f0ffb6", "resource": { "resourceType": "Observation", "id": "8eed5019-e3e7-4d53-b280-e56266f0ffb6", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4548-4", "display": "Hemoglobin A1c/Hemoglobin.total in Blood" } ], "text": "Hemoglobin A1c/Hemoglobin.total in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 6.02, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6c3f57df-b374-9dc4-0f74-a41b92840693", "resource": { "resourceType": "Observation", "id": "6c3f57df-b374-9dc4-0f74-a41b92840693", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 172.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:06886441-b092-0fe8-fccc-9958c781d446", "resource": { "resourceType": "Observation", "id": "06886441-b092-0fe8-fccc-9958c781d446", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 4, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:980a07e0-2a26-e525-1533-6f00eb5cec08", "resource": { "resourceType": "Observation", "id": "980a07e0-2a26-e525-1533-6f00eb5cec08", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 81.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e91742c4-3df9-3fcc-3faf-5e1e37ee58a4", "resource": { "resourceType": "Observation", "id": "e91742c4-3df9-3fcc-3faf-5e1e37ee58a4", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 27.19, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ee3b4adb-462a-f551-a170-59b7f935f3e8", "resource": { "resourceType": "Observation", "id": "ee3b4adb-462a-f551-a170-59b7f935f3e8", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 84, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 125, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b278c4c7-9dcb-9cea-5f70-e2c4b9c34300", "resource": { "resourceType": "Observation", "id": "b278c4c7-9dcb-9cea-5f70-e2c4b9c34300", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 61, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:50592a36-a297-9d3b-b01f-670cbed92608", "resource": { "resourceType": "Observation", "id": "50592a36-a297-9d3b-b01f-670cbed92608", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 16, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c66c5d59-a14f-82b3-e5aa-0da404cdf8f3", "resource": { "resourceType": "Observation", "id": "c66c5d59-a14f-82b3-e5aa-0da404cdf8f3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2339-0", "display": "Glucose [Mass/volume] in Blood" } ], "text": "Glucose [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 89.16, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0d165fb2-fd6a-fb94-6b9f-206d8e3cc5ff", "resource": { "resourceType": "Observation", "id": "0d165fb2-fd6a-fb94-6b9f-206d8e3cc5ff", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6299-2", "display": "Urea nitrogen [Mass/volume] in Blood" } ], "text": "Urea nitrogen [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 13.94, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6003d46a-e414-8d25-cb4a-b11a955a9587", "resource": { "resourceType": "Observation", "id": "6003d46a-e414-8d25-cb4a-b11a955a9587", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "38483-4", "display": "Creatinine [Mass/volume] in Blood" } ], "text": "Creatinine [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 1.05, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:743264ac-373b-b771-7ec8-3524146ad5aa", "resource": { "resourceType": "Observation", "id": "743264ac-373b-b771-7ec8-3524146ad5aa", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "49765-1", "display": "Calcium [Mass/volume] in Blood" } ], "text": "Calcium [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 10.08, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:15ad793e-a0e9-581a-f02b-120e1eb82b3e", "resource": { "resourceType": "Observation", "id": "15ad793e-a0e9-581a-f02b-120e1eb82b3e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2947-0", "display": "Sodium [Moles/volume] in Blood" } ], "text": "Sodium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 140.88, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ce2a6a75-b4f6-e666-2eed-29f07494de04", "resource": { "resourceType": "Observation", "id": "ce2a6a75-b4f6-e666-2eed-29f07494de04", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6298-4", "display": "Potassium [Moles/volume] in Blood" } ], "text": "Potassium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 4.73, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:225d4a4a-ccf4-dc9d-851b-2c334479541d", "resource": { "resourceType": "Observation", "id": "225d4a4a-ccf4-dc9d-851b-2c334479541d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2069-3", "display": "Chloride [Moles/volume] in Blood" } ], "text": "Chloride [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 103.75, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:95cdacc9-49fd-e297-ceee-ae9971ca50bd", "resource": { "resourceType": "Observation", "id": "95cdacc9-49fd-e297-ceee-ae9971ca50bd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "20565-8", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ], "text": "Carbon dioxide, total [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueQuantity": { "value": 24.71, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5366da41-12aa-c93e-714c-7a65ac416ab6", "resource": { "resourceType": "Observation", "id": "5366da41-12aa-c93e-714c-7a65ac416ab6", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9c21995d-d84d-a83e-93dc-7a399101af01", "resource": { "resourceType": "Observation", "id": "9c21995d-d84d-a83e-93dc-7a399101af01", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:46:44-05:00", "issued": "2022-01-10T23:46:44.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA13909-9", "display": "Somewhat" } ], "text": "Somewhat" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30132-7", "display": "5 or more times a week" } ], "text": "5 or more times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30128-5", "display": "Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)" } ], "text": "Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 417100, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6350-8", "display": "Private insurance" } ], "text": "Private insurance" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30138-4", "display": "Part-time or temporary work" } ], "text": "Part-time or temporary work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30193-9", "display": "More than high school" } ], "text": "More than high school" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Stroman Way" }, { "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": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 6, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ea0515f9-78e6-81c0-5ce7-cf714fbfb506", "resource": { "resourceType": "Observation", "id": "ea0515f9-78e6-81c0-5ce7-cf714fbfb506", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-11T00:19:37-05:00", "issued": "2022-01-11T00:19:37.671-05:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0652b576-d388-1227-7e12-846a6af5aac4", "resource": { "resourceType": "Procedure", "id": "0652b576-d388-1227-7e12-846a6af5aac4", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "performedPeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:26:11-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:d69bda99-8613-3e25-cad1-53aea97991ab", "resource": { "resourceType": "Procedure", "id": "d69bda99-8613-3e25-cad1-53aea97991ab", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "performedPeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:202d4787-a131-57e3-644d-84b98aac1e30", "resource": { "resourceType": "Procedure", "id": "202d4787-a131-57e3-644d-84b98aac1e30", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "performedPeriod": { "start": "2022-01-10T23:46:44-05:00", "end": "2022-01-10T23:57:54-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:065c05d2-3246-2c4b-1df9-363fefd85445", "resource": { "resourceType": "Procedure", "id": "065c05d2-3246-2c4b-1df9-363fefd85445", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "performedPeriod": { "start": "2022-01-10T23:57:54-05:00", "end": "2022-01-11T00:19:37-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:63decc33-9a03-b37d-42ae-6d4e2ffa1fb3", "resource": { "resourceType": "SupplyDelivery", "id": "63decc33-9a03-b37d-42ae-6d4e2ffa1fb3", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2022-01-10T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:dabaddaf-8f25-ec7c-bec6-35ed9af04514", "resource": { "resourceType": "SupplyDelivery", "id": "dabaddaf-8f25-ec7c-bec6-35ed9af04514", "status": "completed", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", "code": "device", "display": "Device" } ] }, "suppliedItem": { "quantity": { "value": 50 }, "itemCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" } }, "occurrenceDateTime": "2022-01-10T23:11:11-05:00" }, "request": { "method": "POST", "url": "SupplyDelivery" } }, { "fullUrl": "urn:uuid:d630abc2-fadb-f803-79e6-199a8c728739", "resource": { "resourceType": "MedicationRequest", "id": "d630abc2-fadb-f803-79e6-199a8c728739", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "authoredOn": "2022-01-10T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:15c8225c-e624-f38f-bc37-9c0dfdddc5be", "resource": { "resourceType": "Claim", "id": "15c8225c-e624-f38f-bc37-9c0dfdddc5be", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "created": "2022-01-10T23:46:44-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:d630abc2-fadb-f803-79e6-199a8c728739" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" } ] } ], "total": { "value": 0.81, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e9214ebf-ee1c-d4cb-e688-4f73a3f7ec50", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e9214ebf-ee1c-d4cb-e688-4f73a3f7ec50", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "15c8225c-e624-f38f-bc37-9c0dfdddc5be" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2022-01-10T23:46:44-05:00", "end": "2023-01-10T23:46:44-05:00" }, "created": "2022-01-10T23:46:44-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:15c8225c-e624-f38f-bc37-9c0dfdddc5be" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.81, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:ba4d084d-7bd4-c053-1b1f-4342fbd3e44d", "resource": { "resourceType": "MedicationRequest", "id": "ba4d084d-7bd4-c053-1b1f-4342fbd3e44d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "authoredOn": "2022-01-10T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:dfa28ba0-a2bd-5247-eb73-cd5b36e77f61", "resource": { "resourceType": "Claim", "id": "dfa28ba0-a2bd-5247-eb73-cd5b36e77f61", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "created": "2022-01-10T23:46:44-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:ba4d084d-7bd4-c053-1b1f-4342fbd3e44d" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:dc6b7f71-ee46-2268-df3a-56de4c5a1804", "resource": { "resourceType": "ExplanationOfBenefit", "id": "dc6b7f71-ee46-2268-df3a-56de4c5a1804", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "dfa28ba0-a2bd-5247-eb73-cd5b36e77f61" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2022-01-10T23:46:44-05:00", "end": "2023-01-10T23:46:44-05:00" }, "created": "2022-01-10T23:46:44-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:dfa28ba0-a2bd-5247-eb73-cd5b36e77f61" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:382d3f39-2aba-4e2f-1cb0-5f36c005d099", "resource": { "resourceType": "MedicationRequest", "id": "382d3f39-2aba-4e2f-1cb0-5f36c005d099", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "authoredOn": "2022-01-10T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:caec45e1-3c66-6098-396f-f2ffe2942ea6", "resource": { "resourceType": "Claim", "id": "caec45e1-3c66-6098-396f-f2ffe2942ea6", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "created": "2022-01-10T23:46:44-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:382d3f39-2aba-4e2f-1cb0-5f36c005d099" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" } ] } ], "total": { "value": 1.04, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:c13a224e-8c55-e79b-37f5-853f2c02c7a2", "resource": { "resourceType": "ExplanationOfBenefit", "id": "c13a224e-8c55-e79b-37f5-853f2c02c7a2", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "caec45e1-3c66-6098-396f-f2ffe2942ea6" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2022-01-10T23:46:44-05:00", "end": "2023-01-10T23:46:44-05:00" }, "created": "2022-01-10T23:46:44-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:caec45e1-3c66-6098-396f-f2ffe2942ea6" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1.04, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:e40cb505-3137-25ae-1f16-7098fa7e716e", "resource": { "resourceType": "Immunization", "id": "e40cb505-3137-25ae-1f16-7098fa7e716e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "occurrenceDateTime": "2022-01-10T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:cf8512aa-6df9-8d90-a402-52804c37ea1d", "resource": { "resourceType": "DiagnosticReport", "id": "cf8512aa-6df9-8d90-a402-52804c37ea1d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:c66c5d59-a14f-82b3-e5aa-0da404cdf8f3", "display": "Glucose [Mass/volume] in Blood" }, { "reference": "urn:uuid:0d165fb2-fd6a-fb94-6b9f-206d8e3cc5ff", "display": "Urea nitrogen [Mass/volume] in Blood" }, { "reference": "urn:uuid:6003d46a-e414-8d25-cb4a-b11a955a9587", "display": "Creatinine [Mass/volume] in Blood" }, { "reference": "urn:uuid:743264ac-373b-b771-7ec8-3524146ad5aa", "display": "Calcium [Mass/volume] in Blood" }, { "reference": "urn:uuid:15ad793e-a0e9-581a-f02b-120e1eb82b3e", "display": "Sodium [Moles/volume] in Blood" }, { "reference": "urn:uuid:ce2a6a75-b4f6-e666-2eed-29f07494de04", "display": "Potassium [Moles/volume] in Blood" }, { "reference": "urn:uuid:225d4a4a-ccf4-dc9d-851b-2c334479541d", "display": "Chloride [Moles/volume] in Blood" }, { "reference": "urn:uuid:95cdacc9-49fd-e297-ceee-ae9971ca50bd", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:cc7d1347-cf7e-8a4e-2391-63950a70bad2", "resource": { "resourceType": "DiagnosticReport", "id": "cc7d1347-cf7e-8a4e-2391-63950a70bad2", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-11T00:19:37-05:00", "issued": "2022-01-11T00:19:37.671-05:00", "result": [ { "reference": "urn:uuid:ea0515f9-78e6-81c0-5ce7-cf714fbfb506", "display": "Total score [AUDIT-C]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:62a3f348-1235-1f62-b757-fc94ffabb57a", "resource": { "resourceType": "DiagnosticReport", "id": "62a3f348-1235-1f62-b757-fc94ffabb57a", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, "effectiveDateTime": "2022-01-10T23:11:11-05:00", "issued": "2022-01-10T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:c45cedf8-7e05-a30c-790d-b09e1e4f0a78", "resource": { "resourceType": "DocumentReference", "id": "c45cedf8-7e05-a30c-790d-b09e1e4f0a78", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:62a3f348-1235-1f62-b757-fc94ffabb57a" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2022-01-10T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" } ], "period": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:54a61cd8-e71c-014f-bf7c-1b8e6a1b93b0", "resource": { "resourceType": "Claim", "id": "54a61cd8-e71c-014f-bf7c-1b8e6a1b93b0", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "created": "2022-01-10T23:46:44-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:e40cb505-3137-25ae-1f16-7098fa7e716e" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:b35f5f32-733d-c7a5-96f7-08f145aea8a3" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:0652b576-d388-1227-7e12-846a6af5aac4" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:d69bda99-8613-3e25-cad1-53aea97991ab" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:202d4787-a131-57e3-644d-84b98aac1e30" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:065c05d2-3246-2c4b-1df9-363fefd85445" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" } ] }, { "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": 574.48, "currency": "USD" } }, { "sequence": 4, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "net": { "value": 6.80, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" } }, { "sequence": 9, "procedureSequence": [ 3 ], "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": 10, "procedureSequence": [ 4 ], "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": 11, "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": 1366.86, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f7d56ebe-b37a-4ed7-f53c-6f726955665c", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f7d56ebe-b37a-4ed7-f53c-6f726955665c", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "54a61cd8-e71c-014f-bf7c-1b8e6a1b93b0" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2022-01-10T23:46:44-05:00", "end": "2023-01-10T23:46:44-05:00" }, "created": "2022-01-10T23:46:44-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:54a61cd8-e71c-014f-bf7c-1b8e6a1b93b0" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:b35f5f32-733d-c7a5-96f7-08f145aea8a3" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" } ] }, { "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": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "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": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 574.48, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 114.89600000000002, "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": 459.58400000000006, "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": 574.48, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 574.48, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "337388004", "display": "Blood glucose testing strips (physical object)" } ], "text": "Blood glucose testing strips (physical object)" }, "servicedPeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 6.80, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 5.44, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 6.80, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "servicedPeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "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": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "servicedPeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "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": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "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, "category": { "coding": [ { "system": "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": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "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, "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": "2022-01-10T23:11:11-05:00", "end": "2022-01-10T23:46:44-05:00" }, "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": 1366.86, "currency": "USD" } } ], "payment": { "amount": { "value": 1733.952, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e", "resource": { "resourceType": "Encounter", "id": "35cb2694-fa99-072e-2545-cdbd6fbaef7e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "35cb2694-fa99-072e-2545-cdbd6fbaef7e" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Mr. Aaron697 Bruno518 Ferry570" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } } ], "period": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:72b96a36-e036-a424-3581-195c7f92eab2", "resource": { "resourceType": "Condition", "id": "72b96a36-e036-a424-3581-195c7f92eab2", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "onsetDateTime": "2023-01-16T23:11:11-05:00", "abatementDateTime": "2023-01-16T23:11:11-05:00", "recordedDate": "2023-01-16T23:11:11-05:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:b90d96fb-cb17-a207-64b9-0d5bb8b593cf", "resource": { "resourceType": "Observation", "id": "b90d96fb-cb17-a207-64b9-0d5bb8b593cf", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4548-4", "display": "Hemoglobin A1c/Hemoglobin.total in Blood" } ], "text": "Hemoglobin A1c/Hemoglobin.total in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 6.06, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3e84d189-c353-c23e-f6da-e3b96352d965", "resource": { "resourceType": "Observation", "id": "3e84d189-c353-c23e-f6da-e3b96352d965", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 172.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:761872ac-32dd-8d7a-4e9c-da03cfa058c1", "resource": { "resourceType": "Observation", "id": "761872ac-32dd-8d7a-4e9c-da03cfa058c1", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 2, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:238d20c0-7d11-43f3-41a1-8f564a199b6f", "resource": { "resourceType": "Observation", "id": "238d20c0-7d11-43f3-41a1-8f564a199b6f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 81.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:69cf4603-e492-3d98-fda5-02d011ecb90f", "resource": { "resourceType": "Observation", "id": "69cf4603-e492-3d98-fda5-02d011ecb90f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 27.19, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:258c1cb9-c548-427c-3f6d-7d1b4a0b096f", "resource": { "resourceType": "Observation", "id": "258c1cb9-c548-427c-3f6d-7d1b4a0b096f", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 89, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 127, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:baabf7b9-5fa4-01a3-f9d8-a440aaf5a634", "resource": { "resourceType": "Observation", "id": "baabf7b9-5fa4-01a3-f9d8-a440aaf5a634", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 80, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:13e78b99-65d2-49f3-df3a-b03bd96485d7", "resource": { "resourceType": "Observation", "id": "13e78b99-65d2-49f3-df3a-b03bd96485d7", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 15, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c0d0e1ee-9c8a-acbf-8204-c57c9fba72b2", "resource": { "resourceType": "Observation", "id": "c0d0e1ee-9c8a-acbf-8204-c57c9fba72b2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2339-0", "display": "Glucose [Mass/volume] in Blood" } ], "text": "Glucose [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 67.16, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:65167a89-d8a7-ebd1-3e29-a8324dbf15de", "resource": { "resourceType": "Observation", "id": "65167a89-d8a7-ebd1-3e29-a8324dbf15de", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6299-2", "display": "Urea nitrogen [Mass/volume] in Blood" } ], "text": "Urea nitrogen [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 16.78, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4f8298ab-10f8-7845-7a17-033dbd4b5c64", "resource": { "resourceType": "Observation", "id": "4f8298ab-10f8-7845-7a17-033dbd4b5c64", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "38483-4", "display": "Creatinine [Mass/volume] in Blood" } ], "text": "Creatinine [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 1.11, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6d20a921-3515-5bda-f68c-10f277df3929", "resource": { "resourceType": "Observation", "id": "6d20a921-3515-5bda-f68c-10f277df3929", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "49765-1", "display": "Calcium [Mass/volume] in Blood" } ], "text": "Calcium [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 8.99, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e8c245dd-3eab-b6f5-d5cb-dac0be327c97", "resource": { "resourceType": "Observation", "id": "e8c245dd-3eab-b6f5-d5cb-dac0be327c97", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2947-0", "display": "Sodium [Moles/volume] in Blood" } ], "text": "Sodium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 139.18, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:88985ec5-21d1-9aeb-5a87-403a1509027d", "resource": { "resourceType": "Observation", "id": "88985ec5-21d1-9aeb-5a87-403a1509027d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6298-4", "display": "Potassium [Moles/volume] in Blood" } ], "text": "Potassium [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 4.94, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4bf59bc8-5f57-c47f-0beb-f9323b815a33", "resource": { "resourceType": "Observation", "id": "4bf59bc8-5f57-c47f-0beb-f9323b815a33", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2069-3", "display": "Chloride [Moles/volume] in Blood" } ], "text": "Chloride [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 105.13, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2f0c4c32-7b1d-faa9-3965-074058e34d02", "resource": { "resourceType": "Observation", "id": "2f0c4c32-7b1d-faa9-3965-074058e34d02", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "20565-8", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ], "text": "Carbon dioxide, total [Moles/volume] in Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueQuantity": { "value": 27.13, "unit": "mmol/L", "system": "http://unitsofmeasure.org", "code": "mmol/L" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7d23e1f7-548d-f1fa-1094-2d2c26bae4c3", "resource": { "resourceType": "Observation", "id": "7d23e1f7-548d-f1fa-1094-2d2c26bae4c3", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a8e75362-c3d8-c548-45c8-030b07d90bfd", "resource": { "resourceType": "Observation", "id": "a8e75362-c3d8-c548-45c8-030b07d90bfd", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:59:31-05:00", "issued": "2023-01-16T23:59:31.671-05:00", "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": 417100, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6350-8", "display": "Private insurance" } ], "text": "Private insurance" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30138-4", "display": "Part-time or temporary work" } ], "text": "Part-time or temporary work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30193-9", "display": "More than high school" } ], "text": "More than high school" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Stroman Way" }, { "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": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 6, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:17bfe5bc-ff2d-8dd6-8728-4a781a978623", "resource": { "resourceType": "Observation", "id": "17bfe5bc-ff2d-8dd6-8728-4a781a978623", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-17T00:39:37-05:00", "issued": "2023-01-17T00:39:37.671-05:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:23246217-cd0e-5291-fe3c-98472f8fc7f1", "resource": { "resourceType": "Observation", "id": "23246217-cd0e-5291-fe3c-98472f8fc7f1", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-17T01:16:34-05:00", "issued": "2023-01-17T01:16:34.671-05:00", "valueQuantity": { "value": 2, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:83f20cc8-de40-da6f-e3ef-a2d105a83ef2", "resource": { "resourceType": "Procedure", "id": "83f20cc8-de40-da6f-e3ef-a2d105a83ef2", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "performedPeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:26:11-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:89371e31-0bc0-d47b-d0eb-9b8779a7aef0", "resource": { "resourceType": "Procedure", "id": "89371e31-0bc0-d47b-d0eb-9b8779a7aef0", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "performedPeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:abfcc227-7485-ed63-6c85-27244e631fbc", "resource": { "resourceType": "Procedure", "id": "abfcc227-7485-ed63-6c85-27244e631fbc", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "performedPeriod": { "start": "2023-01-16T23:59:31-05:00", "end": "2023-01-17T00:12:34-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:54ed123e-0b00-eda3-545e-b7a470b278f8", "resource": { "resourceType": "Procedure", "id": "54ed123e-0b00-eda3-545e-b7a470b278f8", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "performedPeriod": { "start": "2023-01-17T00:12:34-05:00", "end": "2023-01-17T00:39:37-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:8c4185e3-064b-620d-5834-ec3cfc6d7ed6", "resource": { "resourceType": "Procedure", "id": "8c4185e3-064b-620d-5834-ec3cfc6d7ed6", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "performedPeriod": { "start": "2023-01-17T00:39:37-05:00", "end": "2023-01-17T00:51:21-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:f7c60f9d-5c62-441f-1dcd-1074f8f9602d", "resource": { "resourceType": "Procedure", "id": "f7c60f9d-5c62-441f-1dcd-1074f8f9602d", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "performedPeriod": { "start": "2023-01-17T00:51:21-05:00", "end": "2023-01-17T01:16:34-05:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:6e7d1323-a3a4-736a-b7a3-aec6298adf33", "resource": { "resourceType": "MedicationRequest", "id": "6e7d1323-a3a4-736a-b7a3-aec6298adf33", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "authoredOn": "2023-01-16T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:1ac19409-d445-17d6-2f67-8c2f36614f96", "resource": { "resourceType": "Claim", "id": "1ac19409-d445-17d6-2f67-8c2f36614f96", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "created": "2023-01-16T23:59:31-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:6e7d1323-a3a4-736a-b7a3-aec6298adf33" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" } ] } ], "total": { "value": 0.51, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:830b3640-22c4-2c9c-3e6e-9e4944e43313", "resource": { "resourceType": "ExplanationOfBenefit", "id": "830b3640-22c4-2c9c-3e6e-9e4944e43313", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "1ac19409-d445-17d6-2f67-8c2f36614f96" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2023-01-16T23:59:31-05:00", "end": "2024-01-16T23:59:31-05:00" }, "created": "2023-01-16T23:59:31-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:1ac19409-d445-17d6-2f67-8c2f36614f96" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310798", "display": "Hydrochlorothiazide 25 MG Oral Tablet" } ], "text": "Hydrochlorothiazide 25 MG Oral Tablet" }, "servicedPeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.51, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:93b8c6f8-854b-4e3b-4385-4e3f93bd14f5", "resource": { "resourceType": "MedicationRequest", "id": "93b8c6f8-854b-4e3b-4385-4e3f93bd14f5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "authoredOn": "2023-01-16T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:e399ea1a-6e3b-af04-b426-b81371837841", "resource": { "resourceType": "Claim", "id": "e399ea1a-6e3b-af04-b426-b81371837841", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "created": "2023-01-16T23:59:31-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:93b8c6f8-854b-4e3b-4385-4e3f93bd14f5" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" } ] } ], "total": { "value": 0.91, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:12d8e6c0-1536-ae35-3761-6719f0243bd5", "resource": { "resourceType": "ExplanationOfBenefit", "id": "12d8e6c0-1536-ae35-3761-6719f0243bd5", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e399ea1a-6e3b-af04-b426-b81371837841" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2023-01-16T23:59:31-05:00", "end": "2024-01-16T23:59:31-05:00" }, "created": "2023-01-16T23:59:31-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:e399ea1a-6e3b-af04-b426-b81371837841" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "314076", "display": "lisinopril 10 MG Oral Tablet" } ], "text": "lisinopril 10 MG Oral Tablet" }, "servicedPeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 0.91, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:96848b4e-a0f7-d22f-e067-526ebe084e12", "resource": { "resourceType": "MedicationRequest", "id": "96848b4e-a0f7-d22f-e067-526ebe084e12", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "authoredOn": "2023-01-16T23:11:11-05:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "reasonReference": [ { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d", "display": "Essential hypertension (disorder)" } ], "dosageInstruction": [ { "sequence": 1, "timing": { "repeat": { "frequency": 1, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:c3db7294-8211-f14b-2234-40e9eaeb6d93", "resource": { "resourceType": "Claim", "id": "c3db7294-8211-f14b-2234-40e9eaeb6d93", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "created": "2023-01-16T23:59:31-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:96848b4e-a0f7-d22f-e067-526ebe084e12" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" } ] } ], "total": { "value": 1.14, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:6cfd6a2a-48e1-2844-ad46-7b2afc97035f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "6cfd6a2a-48e1-2844-ad46-7b2afc97035f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c3db7294-8211-f14b-2234-40e9eaeb6d93" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2023-01-16T23:59:31-05:00", "end": "2024-01-16T23:59:31-05:00" }, "created": "2023-01-16T23:59:31-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:c3db7294-8211-f14b-2234-40e9eaeb6d93" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "308136", "display": "amLODIPine 2.5 MG Oral Tablet" } ], "text": "amLODIPine 2.5 MG Oral Tablet" }, "servicedPeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1.14, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:4307f1a7-a636-24cb-41c7-5db8e8283b0e", "resource": { "resourceType": "Immunization", "id": "4307f1a7-a636-24cb-41c7-5db8e8283b0e", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "occurrenceDateTime": "2023-01-16T23:11:11-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:d4cb773f-8c88-1599-906c-4a6d4065e6c2", "resource": { "resourceType": "DiagnosticReport", "id": "d4cb773f-8c88-1599-906c-4a6d4065e6c2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } ], "result": [ { "reference": "urn:uuid:c0d0e1ee-9c8a-acbf-8204-c57c9fba72b2", "display": "Glucose [Mass/volume] in Blood" }, { "reference": "urn:uuid:65167a89-d8a7-ebd1-3e29-a8324dbf15de", "display": "Urea nitrogen [Mass/volume] in Blood" }, { "reference": "urn:uuid:4f8298ab-10f8-7845-7a17-033dbd4b5c64", "display": "Creatinine [Mass/volume] in Blood" }, { "reference": "urn:uuid:6d20a921-3515-5bda-f68c-10f277df3929", "display": "Calcium [Mass/volume] in Blood" }, { "reference": "urn:uuid:e8c245dd-3eab-b6f5-d5cb-dac0be327c97", "display": "Sodium [Moles/volume] in Blood" }, { "reference": "urn:uuid:88985ec5-21d1-9aeb-5a87-403a1509027d", "display": "Potassium [Moles/volume] in Blood" }, { "reference": "urn:uuid:4bf59bc8-5f57-c47f-0beb-f9323b815a33", "display": "Chloride [Moles/volume] in Blood" }, { "reference": "urn:uuid:2f0c4c32-7b1d-faa9-3965-074058e34d02", "display": "Carbon dioxide, total [Moles/volume] in Blood" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:dfbfe4c2-432c-16df-89ae-ec746aa0d6c2", "resource": { "resourceType": "DiagnosticReport", "id": "dfbfe4c2-432c-16df-89ae-ec746aa0d6c2", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-17T00:39:37-05:00", "issued": "2023-01-17T00:39:37.671-05:00", "result": [ { "reference": "urn:uuid:17bfe5bc-ff2d-8dd6-8728-4a781a978623", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:523134fb-b81d-639f-305c-1c285ae2b821", "resource": { "resourceType": "DiagnosticReport", "id": "523134fb-b81d-639f-305c-1c285ae2b821", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-17T01:16:34-05:00", "issued": "2023-01-17T01:16:34.671-05:00", "result": [ { "reference": "urn:uuid:23246217-cd0e-5291-fe3c-98472f8fc7f1", "display": "Total score [DAST-10]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:edb54751-fcf2-bb2c-371c-b306adb560cd", "resource": { "resourceType": "DiagnosticReport", "id": "edb54751-fcf2-bb2c-371c-b306adb560cd", "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "encounter": { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, "effectiveDateTime": "2023-01-16T23:11:11-05:00", "issued": "2023-01-16T23:11:11.671-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "CjIwMjMtMDEtMTYKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkFhcm9uNjk3CiBpcyBhIDQ4IHllYXItb2xkIG5vbmhpc3BhbmljIHdoaXRlIG1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBwYXJ0LXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKSwgY29uY3Vzc2lvbiBpbmp1cnkgb2YgYnJhaW4gKGRpc29yZGVyKSwgY29uY3Vzc2lvbiB3aXRoIG5vIGxvc3Mgb2YgY29uc2Npb3VzbmVzcywgbm90IGluIGxhYm9yIGZvcmNlIChmaW5kaW5nKSwgZnVsbC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBhY3V0ZSB2aXJhbCBwaGFyeW5naXRpcyAoZGlzb3JkZXIpLCBzdHJlc3MgKGZpbmRpbmcpLgoKIyBTb2NpYWwgSGlzdG9yeQpQYXRpZW50IGlzIG1hcnJpZWQuIFBhdGllbnQgaGFzIG5ldmVyIHNtb2tlZC4KIFBhdGllbnQgaWRlbnRpZmllcyBhcyBoZXRlcm9zZXh1YWwuCgpQYXRpZW50IGNvbWVzIGZyb20gYSBoaWdoIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KIFBhdGllbnQgaXMgYSBjb2xsZWdlIGdyYWR1YXRlLgpQYXRpZW50IGN1cnJlbnRseSBoYXMgVW5pdGVkSGVhbHRoY2FyZS4KCiMgQWxsZXJnaWVzCk5vIEtub3duIEFsbGVyZ2llcy4KCiMgTWVkaWNhdGlvbnMKbGlzaW5vcHJpbCAxMCBtZyBvcmFsIHRhYmxldDsgaHlkcm9jaGxvcm90aGlhemlkZSAyNSBtZyBvcmFsIHRhYmxldDsgYW1sb2RpcGluZSAyLjUgbWcgb3JhbCB0YWJsZXQKCiMgQXNzZXNzbWVudCBhbmQgUGxhbgpQYXRpZW50IGlzIHByZXNlbnRpbmcgd2l0aCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbikuIAoKIyMgUGxhbgpQYXRpZW50IHdhcyBnaXZlbiB0aGUgZm9sbG93aW5nIGltbXVuaXphdGlvbnM6IGluZmx1ZW56YSwgc2Vhc29uYWwsIGluamVjdGFibGUsIHByZXNlcnZhdGl2ZSBmcmVlLiAKVGhlIGZvbGxvd2luZyBwcm9jZWR1cmVzIHdlcmUgY29uZHVjdGVkOgotIG1lZGljYXRpb24gcmVjb25jaWxpYXRpb24gKHByb2NlZHVyZSkKLSBhc3Nlc3NtZW50IG9mIGhlYWx0aCBhbmQgc29jaWFsIGNhcmUgbmVlZHMgKHByb2NlZHVyZSkKLSBkZXByZXNzaW9uIHNjcmVlbmluZyAocHJvY2VkdXJlKQotIGRlcHJlc3Npb24gc2NyZWVuaW5nIHVzaW5nIHBhdGllbnQgaGVhbHRoIHF1ZXN0aW9ubmFpcmUgdHdvLWl0ZW0gc2NvcmUgKHByb2NlZHVyZSkKLSBhc3Nlc3NtZW50IG9mIHN1YnN0YW5jZSB1c2UgKHByb2NlZHVyZSkKLSBzY3JlZW5pbmcgZm9yIGRydWcgYWJ1c2UgKHByb2NlZHVyZSkKVGhlIHBhdGllbnQgd2FzIHByZXNjcmliZWQgdGhlIGZvbGxvd2luZyBtZWRpY2F0aW9uczoKLSBoeWRyb2NobG9yb3RoaWF6aWRlIDI1IG1nIG9yYWwgdGFibGV0Ci0gbGlzaW5vcHJpbCAxMCBtZyBvcmFsIHRhYmxldAotIGFtbG9kaXBpbmUgMi41IG1nIG9yYWwgdGFibGV0Cg==" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:6cf45ac2-f343-6ac6-8221-5d162ea1104c", "resource": { "resourceType": "DocumentReference", "id": "6cf45ac2-f343-6ac6-8221-5d162ea1104c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:edb54751-fcf2-bb2c-371c-b306adb560cd" } ], "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "date": "2023-01-16T23:11:11.671-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291", "display": "Dr. Kayce253 Ondricka197" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" } ], "period": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:df1051cd-4d63-50ca-916b-867432e9bc09", "resource": { "resourceType": "Claim", "id": "df1051cd-4d63-50ca-916b-867432e9bc09", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60", "display": "Aaron697 Ferry570" }, "billablePeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "created": "2023-01-16T23:59:31-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:4307f1a7-a636-24cb-41c7-5db8e8283b0e" } }, { "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" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:72b96a36-e036-a424-3581-195c7f92eab2" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:83f20cc8-de40-da6f-e3ef-a2d105a83ef2" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:89371e31-0bc0-d47b-d0eb-9b8779a7aef0" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:abfcc227-7485-ed63-6c85-27244e631fbc" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:54ed123e-0b00-eda3-545e-b7a470b278f8" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:8c4185e3-064b-620d-5834-ec3cfc6d7ed6" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:f7c60f9d-5c62-441f-1dcd-1074f8f9602d" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" } ] }, { "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, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 668.28, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 6, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 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": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 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": 1447.06, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:826783b3-c2b7-adda-caef-8551719087dc", "resource": { "resourceType": "ExplanationOfBenefit", "id": "826783b3-c2b7-adda-caef-8551719087dc", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "UnitedHealthcare" }, "beneficiary": { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "payor": [ { "display": "UnitedHealthcare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "df1051cd-4d63-50ca-916b-867432e9bc09" }, { "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:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, "billablePeriod": { "start": "2023-01-16T23:59:31-05:00", "end": "2024-01-16T23:59:31-05:00" }, "created": "2023-01-16T23:59:31-05:00", "insurer": { "display": "UnitedHealthcare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|acf8665a-9a46-39ac-b943-afc419b0449e", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" }, "claim": { "reference": "urn:uuid:df1051cd-4d63-50ca-916b-867432e9bc09" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999952291" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:72b96a36-e036-a424-3581-195c7f92eab2" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "UnitedHealthcare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" } ] }, { "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": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "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": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "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": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 668.28, "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": 133.656, "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": 534.624, "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": 668.28, "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": 668.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "51990-0", "display": "Basic metabolic panel - Blood" } ], "text": "Basic metabolic panel - Blood" }, "servicedPeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "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": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "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": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "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": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "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": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "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": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "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": "2023-01-16T23:11:11-05:00", "end": "2023-01-16T23:59:31-05:00" }, "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": 1447.06, "currency": "USD" } } ], "payment": { "amount": { "value": 2548.016, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:36201d1b-743c-7bee-04f7-86c0c64ac7f1", "resource": { "resourceType": "Provenance", "id": "36201d1b-743c-7bee-04f7-86c0c64ac7f1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance" ] }, "target": [ { "reference": "urn:uuid:328cb6c4-843e-26c6-7d6e-a374aba9eb60" }, { "reference": "urn:uuid:bd9f9186-8c3c-3bfc-737d-f82fed89d1a4" }, { "reference": "urn:uuid:44dbcc7b-0022-a40d-8872-92e314ee1e48" }, { "reference": "urn:uuid:e4c71704-4b98-8eeb-35d2-2e86a49a5c0e" }, { "reference": "urn:uuid:08f1b35f-00c2-c60d-e34a-14b1d0e7f9c2" }, { "reference": "urn:uuid:c3d254b5-bd06-857f-e970-038880111c00" }, { "reference": "urn:uuid:45d2e0af-b741-9a22-6e56-5079f00a82e5" }, { "reference": "urn:uuid:437a10c8-8e4b-070e-ee3a-2b641e56426b" }, { "reference": "urn:uuid:1b2a1eef-a1de-e674-87e8-93b4a0e3fdf2" }, { "reference": "urn:uuid:325356ca-5873-2f06-16a4-d87a802ee632" }, { "reference": "urn:uuid:6912c771-3902-d55f-3937-fb27135b36b2" }, { "reference": "urn:uuid:861688c2-43ce-80b5-4921-1f43696c2f88" }, { "reference": "urn:uuid:603589fb-3b2e-1cf5-1157-69c72235d5dd" }, { "reference": "urn:uuid:5fe3f4ca-7e30-2cb5-1b3e-11999850332c" }, { "reference": "urn:uuid:e0e6ef1c-f0fc-3475-1a9d-e59576a375f8" }, { "reference": "urn:uuid:cd916a36-56e3-7c66-5c6b-cf805632c01d" }, { "reference": "urn:uuid:34d5f11b-1528-49a4-5281-8a30bafcd57d" }, { "reference": "urn:uuid:13f5896e-1d14-d8f0-037e-4a29c6e0ca14" }, { "reference": "urn:uuid:6eba9c55-dcec-1abd-d88d-cbae211d8f9b" }, { "reference": "urn:uuid:d8ce0c8d-f739-bc81-1180-127efafbb79f" }, { "reference": "urn:uuid:d2c2660a-e08c-e278-0d05-ec2f5b165c8f" }, { "reference": "urn:uuid:16b1392b-5371-79a3-5b25-8d8dc8a10a4c" }, { "reference": "urn:uuid:b829272e-75e4-910b-844c-80494fb00d94" }, { "reference": "urn:uuid:9eab5d6a-48b7-45a7-a0d1-226afc6d208e" }, { "reference": "urn:uuid:8ba06e78-1b70-51c6-eb62-53f5faa764ac" }, { "reference": "urn:uuid:ec485030-fd22-d7d6-47a9-f3ea97a7bfe9" }, { "reference": "urn:uuid:2937c67c-bf6e-be3e-df12-ad7ee533bef1" }, { "reference": "urn:uuid:223da1d7-f016-486d-a1c3-0641b702c71a" }, { "reference": "urn:uuid:22c191d5-b002-c284-c954-15582fd48035" }, { "reference": "urn:uuid:5187cc2e-5ec0-c2db-3efb-4d4141411cb6" }, { "reference": "urn:uuid:12966c6e-4c6e-080c-1284-5f96e9a7e0b9" }, { "reference": "urn:uuid:43bd4551-6029-27af-bd4e-19ae46ea7d6c" }, { "reference": "urn:uuid:e2c2459b-db7d-658c-277a-e5a25238c26d" }, { "reference": "urn:uuid:180b173f-71fb-1267-2aed-97594ce885e8" }, { "reference": "urn:uuid:514aba1a-7da8-95c6-9f12-0133c96c320a" }, { "reference": "urn:uuid:8c923c5e-5843-25ff-23a6-3f2d2faec208" }, { "reference": "urn:uuid:f751f653-dc7c-cb32-bf47-b10f5c18316c" }, { "reference": "urn:uuid:01e811cf-4968-3d8f-9800-668352b52b05" }, { "reference": "urn:uuid:993333cb-1b71-d8b5-009e-e87bde1778ff" }, { "reference": "urn:uuid:ddac8e64-7e52-847f-b769-7b612c55201b" }, { "reference": "urn:uuid:d2bc4ad0-0774-1ebc-8897-31d22d391f70" }, { "reference": "urn:uuid:95e46130-a4d2-f7c6-c007-6a9cfa7410b8" }, { "reference": "urn:uuid:12ffc493-eaaa-66f9-5851-ab34a39f252c" }, { "reference": "urn:uuid:e145f926-6970-d1f9-8cf0-47f6a06c0555" }, { "reference": "urn:uuid:bd4343ed-67a7-1707-4d4e-7f4b161c0d5a" }, { "reference": "urn:uuid:f825a6ad-4e27-289a-986f-0e1902d7eb40" }, { "reference": "urn:uuid:981bf2b4-83a0-207d-1e31-1fb6d6db7e23" }, { "reference": "urn:uuid:61c70009-0957-e7c2-ea9d-85cb96f3df53" }, { "reference": "urn:uuid:4e51ff28-9c63-81e2-eb8f-93cc9f32594d" }, { "reference": "urn:uuid:408910e7-1f17-d20c-3ceb-39210ac50615" }, { "reference": "urn:uuid:843ea112-0fa7-f609-3ad0-eaddf1b05ab0" }, { "reference": "urn:uuid:b8db4c6f-4482-3463-f27c-d0708b1505ae" }, { "reference": "urn:uuid:986200e9-0419-0c96-8976-03556b314c78" }, { "reference": "urn:uuid:1d795229-7204-560b-23f0-0d86c9b283eb" }, { "reference": "urn:uuid:900a78b9-f447-bf05-d9b3-c412df7e8915" }, { "reference": "urn:uuid:9b711a8a-f234-78ce-7aa1-ee4bd7c9f0b3" }, { "reference": "urn:uuid:fb012dc4-57d1-6f68-7b5b-08b1cd302820" }, { "reference": "urn:uuid:cfb86295-50f2-52ed-7c22-f0c1fa18bb73" }, { "reference": "urn:uuid:e571ead0-1e70-94a3-62a0-44a7feddc1d4" }, { "reference": "urn:uuid:d799f9d5-a4ac-bf3e-b287-6f345d643f58" }, { "reference": "urn:uuid:ed48d042-0618-8fc2-f695-bdb89c30e476" }, { "reference": "urn:uuid:9f6175d6-9cfd-2b95-6207-16200468e046" }, { "reference": "urn:uuid:82257b40-6222-5bcc-791f-78619e87d8a2" }, { "reference": "urn:uuid:4b01d103-03d0-1795-cb5b-abf0792ed04c" }, { "reference": "urn:uuid:7199857b-c4f3-5bd3-de25-828d62b8e7d4" }, { "reference": "urn:uuid:9d953d66-1511-350f-8e50-dde187a16bdd" }, { "reference": "urn:uuid:b3bcc536-73ff-5b22-9e6d-619422951cea" }, { "reference": "urn:uuid:074f67cb-a119-3533-d441-23e24ef9d8c9" }, { "reference": "urn:uuid:e303123c-c79a-8fb6-a29a-67da6583f327" }, { "reference": "urn:uuid:393fd91b-8501-8747-26b6-94b9b447c774" }, { "reference": "urn:uuid:06c6a0e0-9b6e-c456-f00a-c9916246a75f" }, { "reference": "urn:uuid:6d08121b-81cc-8b12-33bb-c4860244a88f" }, { "reference": "urn:uuid:30783dd1-1d35-2dfa-ff8f-e0f123abe957" }, { "reference": "urn:uuid:fd0dcb0e-303e-fd5d-2167-177791a4e854" }, { "reference": "urn:uuid:1ac58b78-6c99-c49f-e95c-10c8487fa848" }, { "reference": "urn:uuid:02c47fbc-7ac2-4300-eb8c-815a2999b6c5" }, { "reference": "urn:uuid:a29f9e9c-1403-2bde-23c5-3c4ae6c63675" }, { "reference": "urn:uuid:b4bb60e2-6a6f-298c-cd10-14ebb75ca022" }, { "reference": "urn:uuid:9d50d939-f203-21cf-6e81-4f3c57c7d9f8" }, { "reference": "urn:uuid:4fa3f59e-46c1-e7aa-3e1c-b2b747759d85" }, { "reference": "urn:uuid:658b0f66-8e64-5adc-a108-b900eb2a9156" }, { "reference": "urn:uuid:e8252fa8-05dd-0a7c-cf76-7ad6f0baab38" }, { "reference": "urn:uuid:cc389283-56d8-d33d-61c2-216efced757b" }, { "reference": "urn:uuid:fd442b19-cc60-a5cc-11ab-ec7caae2337f" }, { "reference": "urn:uuid:41a79569-93fd-d204-1d85-df98fb50bb90" }, { "reference": "urn:uuid:9643c909-bb90-b70f-96f7-7ee4adc4bfd2" }, { "reference": "urn:uuid:7ea6c14f-253d-3de8-e7ca-3a6beaa8327f" }, { "reference": "urn:uuid:a0efe435-3579-5a71-bd64-f609d7960412" }, { "reference": "urn:uuid:1a698ea2-4a67-935f-a76b-bf6277550a1b" }, { "reference": "urn:uuid:12e11c51-0ff7-2226-bc49-a6a0d8a4c299" }, { "reference": "urn:uuid:2927edec-55e0-dfe7-380e-359f78cbd851" }, { "reference": "urn:uuid:c8aa673a-b6d7-05ca-0408-165df76335d6" }, { "reference": "urn:uuid:b159f80a-c94e-f2f9-12ac-c82ffd04cd52" }, { "reference": "urn:uuid:2e1d3cf6-5d3a-03b0-dcf0-0000f3bb294d" }, { "reference": "urn:uuid:0bab0d8f-1da7-ad92-b93d-42da239599fa" }, { "reference": "urn:uuid:4a88e78b-908e-0efa-fe3e-c27dc496d1fa" }, { "reference": "urn:uuid:aa6c1074-8311-0ec9-557a-7db276dc5d2a" }, { "reference": "urn:uuid:82d614a6-72dd-11f2-94bf-c016aa769e96" }, { "reference": "urn:uuid:d83dcc42-0e34-19dc-a5fb-74bc502e2ae9" }, { "reference": "urn:uuid:14be4a47-5585-cb48-e37c-b3abde1a9031" }, { "reference": "urn:uuid:82cfd228-f6b5-7324-80ac-8e396e4d4533" }, { "reference": "urn:uuid:efcc4959-05f1-a68c-a3cf-183071c963de" }, { "reference": "urn:uuid:981b5542-6cc4-cc10-3647-17d9342a9d9a" }, { "reference": "urn:uuid:222c5e0d-b82c-14c0-a037-fc0879bfb188" }, { "reference": "urn:uuid:2e0e565b-140c-45d2-99e6-13acc80f14a9" }, { "reference": "urn:uuid:3e33d384-ed26-6948-fe65-d0cb5e28052e" }, { "reference": "urn:uuid:57212361-4ab0-d9e7-c170-ea012c5fcc15" }, { "reference": "urn:uuid:2bcc4a02-fdd9-ee4e-dfcf-18da69b1ab9f" }, { "reference": "urn:uuid:28b4099b-f9b5-7f4e-530e-0e327070ca5a" }, { "reference": "urn:uuid:39a85eb7-4f82-45c8-1400-c00a1fa7797e" }, { "reference": "urn:uuid:6c4fa4fe-a710-2761-09d1-d806f1e3e07c" }, { "reference": "urn:uuid:2d6c17ac-dbc4-f143-33e2-d30b99af7ee3" }, { "reference": "urn:uuid:b6cc9a12-9fbc-610a-71b6-d85ed7a01800" }, { "reference": "urn:uuid:12305045-ec8f-298a-1322-4067e84c3628" }, { "reference": "urn:uuid:e9da4dd0-e393-22fa-7b17-c03c35b0759c" }, { "reference": "urn:uuid:d6525ce2-384b-040a-d0f5-646ce413bfec" }, { "reference": "urn:uuid:bb015cc6-82de-b376-cd9b-37b3af0f5cde" }, { "reference": "urn:uuid:ab6272ae-3c5f-6ace-30ad-b3430b36d430" }, { "reference": "urn:uuid:1c76bd3e-5820-e707-351a-ee0af2c92c14" }, { "reference": "urn:uuid:3c053d54-c48f-6a27-aadf-6d151e6a57a3" }, { "reference": "urn:uuid:d23629d7-b5c3-09bc-d415-fd9b143cf043" }, { "reference": "urn:uuid:e03513f1-2186-bc69-a227-f0b0a544fff5" }, { "reference": "urn:uuid:104cabb7-cbca-78fc-6d5f-f02226ca6c7e" }, { "reference": "urn:uuid:6f5dc2cd-f93c-4e2b-ff45-94ecd4a3111a" }, { "reference": "urn:uuid:03aa1992-db72-eae3-6645-fa7cc618cc09" }, { "reference": "urn:uuid:51bd2316-0938-a3bf-2901-bb4ffe6b344f" }, { "reference": "urn:uuid:862f85ce-cb71-5db5-9edb-339fc7b55375" }, { "reference": "urn:uuid:cd025b72-0936-d2ad-b31c-4815c57ae0a0" }, { "reference": "urn:uuid:79b73bb4-ec99-f0b0-6b8a-bfd8a8262f9e" }, { "reference": "urn:uuid:6677f847-f292-a5f1-215e-49daf4e1c7ea" }, { "reference": "urn:uuid:d8387fe8-b45b-01cd-bfa8-c9676c2b01c7" }, { "reference": "urn:uuid:db22f0c5-9db1-38a3-8da7-e3b3dfdc8344" }, { "reference": "urn:uuid:8599c81d-1437-923b-4a86-de273a5719f1" }, { "reference": "urn:uuid:2b8fdaff-aa19-6d3f-c5ab-4eb091d2ad6c" }, { "reference": "urn:uuid:4a609758-3b38-85e9-3e71-ee73f833473c" }, { "reference": "urn:uuid:7afcd12b-7d5b-73fd-4213-72ac3a8643dd" }, { "reference": "urn:uuid:0ac0a020-e5f1-93fa-9783-8fcbc8f9011b" }, { "reference": "urn:uuid:a9fbfd50-fc57-9dd6-bf2e-3188135baf8a" }, { "reference": "urn:uuid:e6b0b119-1caa-fad1-f4ab-a848b339d909" }, { "reference": "urn:uuid:9face90f-b8ca-be4a-7d6a-ac6d5cbf3861" }, { "reference": "urn:uuid:7278cfe5-c337-eb1d-154b-e2f1b12095ab" }, { "reference": "urn:uuid:1af9dd5e-e710-6ae8-8b14-ec50f4009537" }, { "reference": "urn:uuid:b42b3946-79ea-4b08-8f02-4d3d32414df0" }, { "reference": "urn:uuid:9c3da9e1-786e-78db-39a4-ec88d03a6b9f" }, { "reference": "urn:uuid:0d8599ae-7583-cabf-348f-a4bb9cfd8622" }, { "reference": "urn:uuid:9d92224e-a22e-7849-ed6c-340851d4cdeb" }, { "reference": "urn:uuid:18d35af3-1f32-cfa0-16d5-3f9a4218eb6e" }, { "reference": "urn:uuid:5cd0f6a1-12c1-470b-00e0-3770a857c242" }, { "reference": "urn:uuid:a7903e50-479e-021e-cc90-aa367359eccd" }, { "reference": "urn:uuid:9d7c9d1a-a92e-2c44-daf8-8c7d2434a908" }, { "reference": "urn:uuid:396867b8-bdc2-e705-83c0-7b5a27e69442" }, { "reference": "urn:uuid:306a37fd-5ab0-3364-185d-0a97161ef342" }, { "reference": "urn:uuid:8402bc9b-a3e0-4428-641a-6662f0629c55" }, { "reference": "urn:uuid:1f00d380-3de6-e6ae-c820-dd5d0b9ddeff" }, { "reference": "urn:uuid:33c63707-f031-ac7c-ec3e-4efad2994085" }, { "reference": "urn:uuid:b5764826-ba27-4d5d-9b42-e90a6816ebaf" }, { "reference": "urn:uuid:d68b71f5-b770-6edb-38d7-c89752b020f0" }, { "reference": "urn:uuid:0c6ea7bd-5b3e-0dea-1dfd-bbf7efe9792a" }, { "reference": "urn:uuid:ddcb2eb1-4cfd-ef34-4d74-5e077cedfec4" }, { "reference": "urn:uuid:59908909-691b-d31b-78fd-776bedd848f9" }, { "reference": "urn:uuid:e475ca6e-d0ac-3457-43ab-1e71b0b2ab13" }, { "reference": "urn:uuid:a7e73b9b-561b-13d1-151b-ff947aa5d5ad" }, { "reference": "urn:uuid:3a9d115f-b0ac-2fc7-f97c-d34a155b837f" }, { "reference": "urn:uuid:f94786ff-c467-2fcc-4953-07199f54aca2" }, { "reference": "urn:uuid:4dc1da1a-7b4f-4437-909d-dd458eb202b2" }, { "reference": "urn:uuid:3645ce80-bcbe-60a2-74c2-b40db8102b9a" }, { "reference": "urn:uuid:edb50283-6725-76d5-ee1c-6e395a7ab703" }, { "reference": "urn:uuid:e0b1ff88-1c3f-84e9-c815-880cc370e894" }, { "reference": "urn:uuid:ed8b1142-e08f-cf8b-f19a-8ae6ab5b9da3" }, { "reference": "urn:uuid:4f8c2933-42ae-f57c-c950-9b1f3480d110" }, { "reference": "urn:uuid:49b2bbfd-233c-03cd-586b-fccb24ef79f7" }, { "reference": "urn:uuid:84df709d-a9f4-24ab-43d8-3f2de137f78e" }, { "reference": "urn:uuid:e6186caa-4a46-9c43-fe6d-20b3973412d9" }, { "reference": "urn:uuid:ba7dc30b-a6c3-bda8-2632-73ce4c640710" }, { "reference": "urn:uuid:94148b62-832d-3e59-782c-b4a9eed96294" }, { "reference": "urn:uuid:6b06ae4c-b4c7-dcb6-97f4-250b1f6fe276" }, { "reference": "urn:uuid:4059839e-793a-d0c3-79fe-cea1e2ea0a73" }, { "reference": "urn:uuid:56c7cb60-d934-8948-06dc-2942f3cee2f2" }, { "reference": "urn:uuid:59069952-f167-a058-cb9c-4ebcdfcf1845" }, { "reference": "urn:uuid:ba582c78-5e97-7475-1cc6-81b226367d6f" }, { "reference": "urn:uuid:cda1fb31-8c9b-9729-3bc6-e687b5678641" }, { "reference": "urn:uuid:cea98653-a117-8a6a-bcdf-20f4de6dddbf" }, { "reference": "urn:uuid:588b7e9b-dc6f-e52a-195b-525006d9024c" }, { "reference": "urn:uuid:b4391a65-40e6-f132-262b-089e7c9f7b7f" }, { "reference": "urn:uuid:e910cf4e-d12f-2c9f-6c89-cb518598e3d6" }, { "reference": "urn:uuid:daa32f4e-227c-74be-c0f9-1963dbe4487d" }, { "reference": "urn:uuid:329c15f9-9180-752a-3f13-07b9fb507600" }, { "reference": "urn:uuid:748db7c8-d2fc-8966-7c46-c7db86423eae" }, { "reference": "urn:uuid:b490d022-d300-0b88-b9ae-c98ec227f305" }, { "reference": "urn:uuid:d7ea6c3e-c388-5e65-257d-2318fbc0e809" }, { "reference": "urn:uuid:408bf0d7-8113-1334-e636-f015ea074f8b" }, { "reference": "urn:uuid:59a1471f-307a-4571-ba46-498acea8d0ad" }, { "reference": "urn:uuid:d5a064f3-47e0-5103-ab2b-2b3af151a4a4" }, { "reference": "urn:uuid:25cca44d-a91e-46a0-8f44-da38bd063bbf" }, { "reference": "urn:uuid:92507ba6-06a5-08f0-0863-f33ba75f7fea" }, { "reference": "urn:uuid:8a5df4ca-024a-8e19-355d-52b34c2371b3" }, { "reference": "urn:uuid:a62e6b71-3a5b-4ac0-52b8-8041802a73da" }, { "reference": "urn:uuid:e724dbbf-fe73-843f-ac3b-d5ffd9cfee22" }, { "reference": "urn:uuid:bd58e18d-885b-2f4a-e0c7-58e254e2e51a" }, { "reference": "urn:uuid:1f87036f-6aac-41ca-4cb7-139a12d9e00e" }, { "reference": "urn:uuid:0c5b4a0d-e66d-0895-4cd4-0cc8a7a97a47" }, { "reference": "urn:uuid:18c1de69-efb8-efbd-7cee-d3420ff47032" }, { "reference": "urn:uuid:d33befd7-6380-a5b0-6f39-0aa62bcd9d65" }, { "reference": "urn:uuid:9fdb3ebe-4a64-da12-98ab-7f3177149217" }, { "reference": "urn:uuid:68453cdb-8892-7e56-3b77-afefe96440d1" }, { "reference": "urn:uuid:1bcf80d0-978c-d4c9-1bdf-2e6c84f48175" }, { "reference": "urn:uuid:585434f3-ea4d-ddee-74d0-4d26bcb431ad" }, { "reference": "urn:uuid:1379d61b-7320-8b3d-a5c2-7a065224473a" }, { "reference": "urn:uuid:51e599db-8079-540d-fd55-5cb1f425d60e" }, { "reference": "urn:uuid:d45581c0-3fc2-f1ad-fa95-97a7de238932" }, { "reference": "urn:uuid:95e1b306-573f-049f-c737-34748959e5b5" }, { "reference": "urn:uuid:9e9e7208-94a3-116f-4740-905c93d7a7d9" }, { "reference": "urn:uuid:77b3deb1-c7ea-d849-0f69-a0cb7ed2afe9" }, { "reference": "urn:uuid:e8290f08-5747-e6c4-c8c8-f31bd1de25bf" }, { "reference": "urn:uuid:bef2ec4f-a4e0-ffa6-6dca-d77f02e90144" }, { "reference": "urn:uuid:0c4c5885-79e7-4d56-aff3-31ade319387f" }, { "reference": "urn:uuid:a7bffd11-4110-64f2-4fe1-da5515b519a4" }, { "reference": "urn:uuid:ce660bfa-4e43-e1ca-09c3-bbd0acfff1d6" }, { "reference": "urn:uuid:22c3565c-b371-4297-a0cf-258db3f352f7" }, { "reference": "urn:uuid:15e73242-6a72-7e2a-e368-7b6640ec69ec" }, { "reference": "urn:uuid:03c21cec-ff30-4eb4-7be2-2363ba8ffb71" }, { "reference": "urn:uuid:b96de3fd-0981-69e0-81cf-da91cc3f7932" }, { "reference": "urn:uuid:a33258b4-9ba7-63f9-d020-b06d1852fc00" }, { "reference": "urn:uuid:1b539e01-dd7a-c270-d2b2-a0be3003aea9" }, { "reference": "urn:uuid:c26092f2-4127-ea55-22cd-d90c46d2eac0" }, { "reference": "urn:uuid:6eca3ce9-88cf-6eef-cf76-8617dece1dea" }, { "reference": "urn:uuid:e9dd7cb2-eb95-6093-11e7-dec566608327" }, { "reference": "urn:uuid:1e62fe13-1c21-7a44-c5d2-c7d618caadad" }, { "reference": "urn:uuid:8ac1bcc4-89ca-2f76-9d5b-97b1b5fad8de" }, { "reference": "urn:uuid:0742712c-3f5f-5b66-8c8d-b1c10e36c4c7" }, { "reference": "urn:uuid:5b024704-0a82-40aa-4ceb-ede3d0a04ab0" }, { "reference": "urn:uuid:ce8e33e5-d56d-ffb1-7d66-1f153376014f" }, { "reference": "urn:uuid:3ce16797-6bca-2293-51f2-15c043382825" }, { "reference": "urn:uuid:767d0188-3ab4-3f35-c3f8-5b778d7a96f2" }, { "reference": "urn:uuid:fc74bdd9-f880-380e-6afb-53130e7b5aa7" }, { "reference": "urn:uuid:899c6a00-9ec6-8dbe-c04f-78455b8b311b" }, { "reference": "urn:uuid:9b8c300d-bb6f-12fa-6fc4-42aa625e9de7" }, { "reference": "urn:uuid:b0abf504-c267-fe82-701e-f84ab72c6cc3" }, { "reference": "urn:uuid:c080b1a9-84b8-1cc6-7be0-6e7edc58233d" }, { "reference": "urn:uuid:0f286b67-cb78-84b5-b9d7-ab94b8ef442e" }, { "reference": "urn:uuid:22f7d12f-4187-dea9-b580-c908e41bcebf" }, { "reference": "urn:uuid:6e97deba-6a1f-ae47-86ec-92c3b70d24dd" }, { "reference": "urn:uuid:c42d974f-a254-3ea9-2fe2-481247f48811" }, { "reference": "urn:uuid:f6a84725-9a47-db21-4806-8fab2b145201" }, { "reference": "urn:uuid:3522e476-e97e-3e6e-03fa-506e84293271" }, { "reference": "urn:uuid:cf07c908-307b-c848-a48c-0f1d8fa4bfb3" }, { "reference": "urn:uuid:89957403-e199-8cd4-d5b6-6ddc71141ec5" }, { "reference": "urn:uuid:5c3d6c90-b8b9-69db-dbb9-4b1e65d2ccc5" }, { "reference": "urn:uuid:96eaa344-bc28-966d-40d3-29c8a2c8233b" }, { "reference": "urn:uuid:8c5e5ce1-2e29-f1f1-90ba-6643dc2d24e4" }, { "reference": "urn:uuid:db8e91bc-a541-e56d-7197-ae1962a46083" }, { "reference": "urn:uuid:7822c7e7-cf21-0649-ed43-5135663d46ad" }, { "reference": "urn:uuid:7755f221-44db-4c25-e078-5fef5eff1199" }, { "reference": "urn:uuid:cd8c1821-2538-c8a6-a33c-edc12457d610" }, { "reference": "urn:uuid:e89dab52-6864-9814-7948-756d9d7d0452" }, { "reference": "urn:uuid:2360deab-5dff-ce0c-5b6d-b44aa7ea4665" }, { "reference": "urn:uuid:de33e67c-d7c0-90a7-8d35-872d0a65ea53" }, { "reference": "urn:uuid:9c284f62-a29f-1eb1-db14-29c3d37335a9" }, { "reference": "urn:uuid:a06ef7f6-ad63-f427-5042-71f188ba5469" }, { "reference": "urn:uuid:0e59e987-3012-c6d6-3d76-b99e8d486055" }, { "reference": "urn:uuid:a3d68807-a5f6-2942-0662-11c88a32186d" }, { "reference": "urn:uuid:1d464d49-b507-f7c8-5065-12ddaa2c0cb5" }, { "reference": "urn:uuid:9d4b836c-ca90-f406-1050-de4ca893423a" }, { "reference": "urn:uuid:ef78b5d5-a281-3e69-24cd-4930c5995034" }, { "reference": "urn:uuid:0bd57425-1f94-2b60-08fe-e70c593fca8f" }, { "reference": "urn:uuid:05cc85fc-9d19-3671-3710-3c870f786fac" }, { "reference": "urn:uuid:c19ca3d3-9ce1-95ff-d142-775cb822f345" }, { "reference": "urn:uuid:29b8ab7c-7192-1801-86bf-e83d9657e38f" }, { "reference": "urn:uuid:92eac34d-569a-6eca-a681-3fd5d0be8eed" }, { "reference": "urn:uuid:bc8cc4b5-557c-3f5c-05bb-5d5b89cb07f5" }, { "reference": "urn:uuid:b21717c0-1805-38ad-577e-de9e5251e4b9" }, { "reference": "urn:uuid:1673e908-f29b-4ad1-a1ae-2c742d9beb89" }, { "reference": "urn:uuid:d4ea4536-f24c-e1ed-74f9-9487224d1320" }, { "reference": "urn:uuid:e5e77639-514f-d19d-98d4-70ceff7ac4ad" }, { "reference": "urn:uuid:9e6283bd-a336-e2cc-844a-b4d2c22159f5" }, { "reference": "urn:uuid:37efe43e-9180-4cee-06c7-5043165df8f1" }, { "reference": "urn:uuid:2c8819b6-59d8-3c1a-66c2-b14c874e12ff" }, { "reference": "urn:uuid:4a9c7a9f-bb6d-c9f1-aeff-1375f757a3f9" }, { "reference": "urn:uuid:e862d12c-3f4a-6d79-6d40-7d2f0e21d97e" }, { "reference": "urn:uuid:33308711-c96b-a50b-abf2-27e79c55316a" }, { "reference": "urn:uuid:5478a57b-af20-52c8-a2bd-2db2bbbd7d40" }, { "reference": "urn:uuid:269c5e24-9c30-bda1-86a2-d4dffc54e48e" }, { "reference": "urn:uuid:9c91b907-b73b-40c4-6709-062c812422fb" }, { "reference": "urn:uuid:d9cb4d38-4c23-7cdb-6f77-8c1b68de2348" }, { "reference": "urn:uuid:c3be9163-8f57-cac6-16d1-5320a61f94ed" }, { "reference": "urn:uuid:8282b292-ed9c-327a-253e-255a128d9357" }, { "reference": "urn:uuid:0148bf52-3488-4d43-2d6d-60ba6d37dc05" }, { "reference": "urn:uuid:988d94e7-52c4-9535-2944-b9a9c9d457e4" }, { "reference": "urn:uuid:5b01920b-9f6c-888b-6d9b-6cf8cb9d31f3" }, { "reference": "urn:uuid:1a0b17ae-3992-4283-9f56-58430869abe4" }, { "reference": "urn:uuid:b61ee916-9688-7802-6c54-397fa95afe4c" }, { "reference": "urn:uuid:1118c36e-fe4c-3144-c699-1d49ebccc1df" }, { "reference": "urn:uuid:f9110bf5-6a7b-91b0-02e9-8bd34e4bc232" }, { "reference": "urn:uuid:c4670fdb-6f15-bef6-4eba-2ac290640a62" }, { "reference": "urn:uuid:78691e7d-5dcb-a564-fb84-7fbb85ccc0b3" }, { "reference": "urn:uuid:85a6a838-5779-918a-25f0-0fa40c2a5430" }, { "reference": "urn:uuid:1b636f20-8b95-b0a2-a178-9c22ded10e47" }, { "reference": "urn:uuid:6a21d47c-ae45-458d-5395-238935b16042" }, { "reference": "urn:uuid:5effa714-223e-0345-bcaf-c2ee6b960e80" }, { "reference": "urn:uuid:714518d7-9210-708e-cfb9-bc2705d7a886" }, { "reference": "urn:uuid:e5d97032-45bc-c175-ed44-1d070d2ccc08" }, { "reference": "urn:uuid:670e9eea-e958-872a-28b2-23152f6ff7e7" }, { "reference": "urn:uuid:4ab4855e-186a-ca0e-77a1-fc1f043a8dce" }, { "reference": "urn:uuid:f5317120-dee5-5984-6456-c65e76c050ab" }, { "reference": "urn:uuid:25a862b1-0eb3-1e5c-d66b-0851581a8a10" }, { "reference": "urn:uuid:e451178c-1a30-7bca-1fae-bd122f5d7e1e" }, { "reference": "urn:uuid:98a621fd-1bc3-722b-d6d2-1a2f9077d514" }, { "reference": "urn:uuid:bac155d7-1939-78c8-3b1b-30c49b111850" }, { "reference": "urn:uuid:933cc9dd-170e-1a0f-e9a6-5305d6feece0" }, { "reference": "urn:uuid:8bb98acf-9b16-58c9-def4-e875212b85cb" }, { "reference": "urn:uuid:6b9de700-1f1d-53cf-1505-f999fa0a8000" }, { "reference": "urn:uuid:0268b729-7a0a-b78b-c543-44548043f888" }, { "reference": "urn:uuid:99ec046d-462c-7e3d-4fc7-0869c49f7ef1" }, { "reference": "urn:uuid:1f411c65-ccd2-5ade-1752-4fbea05cf06f" }, { "reference": "urn:uuid:64609afa-25c3-11ac-285b-025e1e74bbe3" }, { "reference": "urn:uuid:6df6547d-4f34-8700-38b2-222d612291c8" }, { "reference": "urn:uuid:3b0350f6-a9ab-b72c-d327-6ab037615a0e" }, { "reference": "urn:uuid:4c248001-6ac0-e9f4-d4b5-7dce0663e072" }, { "reference": "urn:uuid:f901986e-6f5d-e321-472f-c8682fffecae" }, { "reference": "urn:uuid:ea145f46-2467-0ef6-db42-f7f723d32890" }, { "reference": "urn:uuid:43ec259d-1785-4ac2-89f8-9f9235738176" }, { "reference": "urn:uuid:100d9778-62b1-1497-fcf1-fa063ffbe821" }, { "reference": "urn:uuid:592567b1-2419-94b3-589e-1cc6af64801b" }, { "reference": "urn:uuid:38f2d12f-6f87-afd6-bcb8-47f0d6fbab28" }, { "reference": "urn:uuid:198f0340-77d3-05e0-6f84-287c33ea5ddc" }, { "reference": "urn:uuid:0222e63c-9b7a-9984-53e0-0707f6e13318" }, { "reference": "urn:uuid:bd1ff25e-0b74-4304-27c3-e74461fdeb97" }, { "reference": "urn:uuid:3b4c066f-a00c-d2d3-adff-9fc427940b2e" }, { "reference": "urn:uuid:1f2775c3-58d5-3a7b-a322-1b16cb8b8655" }, { "reference": "urn:uuid:afd18167-e0be-dfc0-4d6b-16186bbe43e5" }, { "reference": "urn:uuid:c41eb09b-dd07-7e05-83e9-ef842b057722" }, { "reference": "urn:uuid:c94f0308-0579-cb48-a7b1-182d3a4bef91" }, { "reference": "urn:uuid:2efea857-8d4f-60c8-d006-7e727c9e11fe" }, { "reference": "urn:uuid:31deff32-fa35-2d53-0d38-dca0771fb8f6" }, { "reference": "urn:uuid:3e3c8c0b-bf9a-278b-8890-471ebd768460" }, { "reference": "urn:uuid:ba3f6772-2493-5095-0f81-8abe286219c9" }, { "reference": "urn:uuid:45e5b53c-63c5-e125-1b83-dbfc8c0f26f6" }, { "reference": "urn:uuid:4039da8b-2dd0-2534-34c6-5210e0e9d70b" }, { "reference": "urn:uuid:50825d43-9a8b-1ced-937c-e9245a6b0ecb" }, { "reference": "urn:uuid:2858432b-3356-2906-f090-6a2c701fa717" }, { "reference": "urn:uuid:0528c518-c916-f251-a9fb-7c5bc9c9381d" }, { "reference": "urn:uuid:a22ae39a-902a-8f48-3353-1177a95e32ec" }, { "reference": "urn:uuid:d51803ab-d757-3653-7b55-48e83b844b66" }, { "reference": "urn:uuid:d996f883-b016-b408-9911-5844225e2d1f" }, { "reference": "urn:uuid:5fc22cec-e252-b78f-c262-33639db3531f" }, { "reference": "urn:uuid:2fc38f04-d5f2-0cc4-31ba-0d0aeb45b2f4" }, { "reference": "urn:uuid:c7ce50fa-eb1e-2f18-3d0a-9e170ad0d129" }, { "reference": "urn:uuid:d6fd6ac2-f237-6867-9f2e-bace2d9518b5" }, { "reference": "urn:uuid:12fc5fb4-47ae-7c72-016a-f5efcea8532e" }, { "reference": "urn:uuid:eb2fd983-9660-0f91-980f-9457a9149439" }, { "reference": "urn:uuid:24123b14-be51-7dac-8fc8-44cdc47b7e13" }, { "reference": "urn:uuid:486c2675-11e0-771f-52fd-7ca7fcad8e94" }, { "reference": "urn:uuid:c9d7bc7d-ecb7-39ef-1001-5ccc963415fc" }, { "reference": "urn:uuid:80504901-e6b4-5eed-320a-23e9f545ad8a" }, { "reference": "urn:uuid:3d5b364f-2d49-6501-c048-ea713e248f6d" }, { "reference": "urn:uuid:405f6e3e-c757-f063-932f-93727d3248c4" }, { "reference": "urn:uuid:6dd68590-7523-8947-4099-9026f64926f6" }, { "reference": "urn:uuid:0436776b-084d-a27c-cdb5-a3178e95b0c9" }, { "reference": "urn:uuid:0a5fc25a-8148-584d-cb96-e31fc17545c3" }, { "reference": "urn:uuid:0afb6d9e-22fe-ac09-6244-c455de7e3aae" }, { "reference": "urn:uuid:8f873314-1372-8035-4cd5-65d6e2d4fc0f" }, { "reference": "urn:uuid:b03ccf19-9f7c-f45b-a58f-8efdbc5bf173" }, { "reference": "urn:uuid:7d5f46eb-d094-8037-c4f2-d779e7f7951a" }, { "reference": "urn:uuid:8ca76c4a-b087-14a4-9a2c-98a3f189f263" }, { "reference": "urn:uuid:710d0610-2b99-7a52-1eb9-461fdd2726a3" }, { "reference": "urn:uuid:7bea288a-a56c-af4a-acbc-f0439596453d" }, { "reference": "urn:uuid:96e6fa56-d543-1329-beec-44f4cd9ccdc8" }, { "reference": "urn:uuid:e5cdc575-2b12-5760-b35d-4e29239282e5" }, { "reference": "urn:uuid:f74b9dfc-f6ff-8ea4-9ba8-6403692b5067" }, { "reference": "urn:uuid:e9e4b4db-5e05-73fa-537b-ecbdfbd6244d" }, { "reference": "urn:uuid:badd9121-0f40-1334-5d27-d080bb6ba1d3" }, { "reference": "urn:uuid:00202a10-031a-c30b-6d98-9409035508a8" }, { "reference": "urn:uuid:86a7d5f2-8508-ed60-84e8-f423be8310e5" }, { "reference": "urn:uuid:32ad8c3b-9afa-9092-b89e-6e72f2c43e82" }, { "reference": "urn:uuid:6953a5ec-6687-020f-b61f-12704e68780a" }, { "reference": "urn:uuid:5ea2c037-b468-c62d-edc4-deb1d7fad492" }, { "reference": "urn:uuid:4b9fa569-1d3e-913a-4273-2e6f5ef5d4e7" }, { "reference": "urn:uuid:8f64dc28-b06c-046f-c4c2-f72f6dadfad0" }, { "reference": "urn:uuid:a309bb3f-253e-a045-0aa4-c2e351e4e2fe" }, { "reference": "urn:uuid:10123dd0-cc40-0d4f-5720-c43f42961552" }, { "reference": "urn:uuid:128867b2-46da-9ba4-7bb6-61173facdf0e" }, { "reference": "urn:uuid:51f161c6-ee07-09df-f373-82a578ee67c0" }, { "reference": "urn:uuid:4d561606-a74a-9e21-d255-956d3236a59f" }, { "reference": "urn:uuid:a4fb6084-0606-85fe-a2cd-b4739d2fdfba" }, { "reference": "urn:uuid:3eb7a88f-e664-56a6-8af6-9fe67d635e8f" }, { "reference": "urn:uuid:9b420eda-8edb-f5fb-6bee-6f2d32ca4e4a" }, { "reference": "urn:uuid:13b9d7d1-4731-92cf-7354-c40246658e10" }, { "reference": "urn:uuid:a07cbc27-2293-3f74-718d-e00a0a1a904d" }, { "reference": "urn:uuid:3b30a2d5-9821-a60e-b908-8353164ef6f8" }, { "reference": "urn:uuid:9eda2b8c-1ff9-3e2d-edd1-03c8cf6afbee" }, { "reference": "urn:uuid:1703ce91-a876-b0d7-7841-7cd49fc87eaf" }, { "reference": "urn:uuid:6164d450-8690-47c5-ee04-884e1b6de277" }, { "reference": "urn:uuid:93033e60-3285-3e90-cdff-412f09f160ef" }, { "reference": "urn:uuid:48f09cfb-5db7-b09f-2b91-03bbf31a590c" }, { "reference": "urn:uuid:f1ab31c3-1c18-00b9-3a53-c9c97f779c41" }, { "reference": "urn:uuid:f6d3e033-43c5-2814-3b92-562b4562d6ed" }, { "reference": "urn:uuid:839db0dc-e4cb-b0e4-84cb-dd79c141a129" }, { "reference": "urn:uuid:01aff673-f092-d056-25c7-48f81b958069" }, { "reference": "urn:uuid:550b906a-57c2-4643-3014-283916c2f9f9" }, { "reference": "urn:uuid:32cc211f-bf94-be74-5c17-009f44822766" }, { "reference": "urn:uuid:2a5c6003-4d32-c5d1-54d6-fb42d9e57c06" }, { "reference": "urn:uuid:26e0c267-f011-1410-8526-a23640ccfaa9" }, { "reference": "urn:uuid:6634a10b-5e13-8103-1188-a0c8abddb500" }, { "reference": "urn:uuid:b8d55dda-9866-4749-e225-b432c1fc82b0" }, { "reference": "urn:uuid:88560b47-b3cc-589d-dd0a-1494a142eeb5" }, { "reference": "urn:uuid:1ee0c726-0ec5-a18a-d391-89cbaf0f08f5" }, { "reference": "urn:uuid:85102589-8403-d44f-2305-1bc8ec969b15" }, { "reference": "urn:uuid:a46e8cfa-e640-7f24-ad06-5bb9e6f434ff" }, { "reference": "urn:uuid:b70af917-e83b-8f79-4d62-9245db5165f4" }, { "reference": "urn:uuid:db68f72e-e40c-bc25-2404-546540376a8b" }, { "reference": "urn:uuid:d342197a-bae8-fa58-fefc-d76d45484a0b" }, { "reference": "urn:uuid:bbf29686-1760-9762-ad5a-ec0728a14a56" }, { "reference": "urn:uuid:bc872584-e95a-726f-eae1-b47273f2737f" }, { "reference": "urn:uuid:0fab9eaf-f405-ba86-508e-345f1e3d5735" }, { "reference": "urn:uuid:94a6460f-604d-7e17-8f44-2b427246b6c2" }, { "reference": "urn:uuid:5d85205c-b696-c45d-e14d-53ac119c5c35" }, { "reference": "urn:uuid:e859f748-cba9-1978-c4f1-2f37630e3308" }, { "reference": "urn:uuid:df2728e1-366c-ef28-0676-c3b6d304bc8a" }, { "reference": "urn:uuid:bcad1165-465d-ef2a-41f9-3350248a0246" }, { "reference": "urn:uuid:0f1f7983-9ffc-e0ac-b476-74cbd9ff5f33" }, { "reference": "urn:uuid:b7b4155c-63c8-240d-346e-17e49977ad15" }, { "reference": "urn:uuid:c3158c1a-8ed2-178a-444e-0ae487bb55dd" }, { "reference": "urn:uuid:129d0fd6-961f-3476-ba80-28a17886fc97" }, { "reference": "urn:uuid:9ced1e9d-4872-3cca-c3ee-31a566915086" }, { "reference": "urn:uuid:a14ec0c9-c06f-3ce0-092f-a4af9b786e8c" }, { "reference": "urn:uuid:6d73d898-e046-657b-49d8-2a61a6d974cf" }, { "reference": "urn:uuid:432f4ea7-659e-ee80-9d2e-f68c31d43578" }, { "reference": "urn:uuid:5484f819-0383-2c76-c088-62b1b3051002" }, { "reference": "urn:uuid:e2aaf5dc-a1bd-b1ff-49b5-df1beef8416e" }, { "reference": "urn:uuid:256503cf-81ba-57fd-15d3-b7882e38d493" }, { "reference": "urn:uuid:b1671f9b-4543-0856-35ae-9edf7a5e926f" }, { "reference": "urn:uuid:b779d47b-aadc-5564-f600-acf96b8649b0" }, { "reference": "urn:uuid:d38e57bf-6e35-5905-3411-b55135df14a9" }, { "reference": "urn:uuid:f98a7874-9148-8611-cedd-f706a9a2d2f6" }, { "reference": "urn:uuid:46601053-dc5e-8128-7d1f-e3cddf6d20b3" }, { "reference": "urn:uuid:2c13f4c3-6a16-2e14-a277-8e89b1228726" }, { "reference": "urn:uuid:3f782e73-6e20-7529-10bb-8bcea31e8318" }, { "reference": "urn:uuid:bf987d8b-2e26-db57-05eb-eaaa5f3ad0eb" }, { "reference": "urn:uuid:296e8fcb-c1fb-2f04-a96a-f1e06d2e5eb8" }, { "reference": "urn:uuid:74474064-428a-62c0-b57f-5806a1d2f995" }, { "reference": "urn:uuid:02f070b8-76ae-d052-7d88-07a8512f53a1" }, { "reference": "urn:uuid:4b164130-e3f6-3e2e-3e2a-61c9b77f8559" }, { "reference": "urn:uuid:cfd6b883-ea32-d3a7-09f1-8167247e8e8b" }, { "reference": "urn:uuid:7c13c058-c623-f2a4-e334-78688b45ae22" }, { "reference": "urn:uuid:97186871-12ab-e9ec-7fbd-89ec4c70d3ad" }, { "reference": "urn:uuid:479f3600-f5b9-8a50-0689-bb266f8592f3" }, { "reference": "urn:uuid:058813a6-3465-be7b-2814-afddcc47b201" }, { "reference": "urn:uuid:8552664e-8842-7fc0-8275-06ea6c66db92" }, { "reference": "urn:uuid:f1ae30b7-1e81-8f8b-5576-29275659a7e4" }, { "reference": "urn:uuid:cd40796a-99bc-d1a5-1f64-a3754a8c08d6" }, { "reference": "urn:uuid:a914f542-6e22-a998-8739-3db55d884d7c" }, { "reference": "urn:uuid:8ce36245-c2c9-66d4-fd8f-49e8cec673f6" }, { "reference": "urn:uuid:dc8d87c4-3fcc-78ae-3f26-5b0c416a2787" }, { "reference": "urn:uuid:bcd94379-2c48-b2f5-1e8a-984c3466c2d3" }, { "reference": "urn:uuid:c86cf5b6-7d8d-60ba-4738-81ab08058195" }, { "reference": "urn:uuid:edc80b67-b382-746c-b462-4b94a0f93781" }, { "reference": "urn:uuid:32fe1d54-6197-58c3-9cce-f9a35826ddfb" }, { "reference": "urn:uuid:6ea75667-2e7c-00a0-c787-adb9f96607c0" }, { "reference": "urn:uuid:face4c9b-b5cb-4e97-9ed1-1b7321fc9b01" }, { "reference": "urn:uuid:b5d95d9b-e887-33fc-70ef-2e382861a2f1" }, { "reference": "urn:uuid:145656fd-43a4-020a-f594-883322db2c9a" }, { "reference": "urn:uuid:d091b7ec-5cd5-79cc-a980-cb21bb68e877" }, { "reference": "urn:uuid:3a00b812-205c-8583-f126-b1232e1d0de2" }, { "reference": "urn:uuid:41057f68-c476-89d1-a107-a79af466173c" }, { "reference": "urn:uuid:df90c3c0-c9ce-ec17-b00b-03782734dd72" }, { "reference": "urn:uuid:05c41e18-d983-a78d-9f9f-0b450a2d0f9f" }, { "reference": "urn:uuid:e3f93e5f-9c6a-1e81-2f39-d32e73d38007" }, { "reference": "urn:uuid:9266aa93-d81c-6046-ccb9-f0199f1cbf4a" }, { "reference": "urn:uuid:9b762631-84b5-e6f6-02e1-dc4a2aeab8f7" }, { "reference": "urn:uuid:4041105f-555c-1224-5c10-32b5d8fe3f23" }, { "reference": "urn:uuid:b3813f2b-ac4c-3585-26ab-0784bce37d52" }, { "reference": "urn:uuid:7c0666eb-8a17-5bc4-18c0-1901ffc52f0b" }, { "reference": "urn:uuid:9bdd28d7-5e8c-9445-d5b8-d5bd0e4b5c43" }, { "reference": "urn:uuid:04faa266-7cbf-f3dd-79d3-4799c15a34bb" }, { "reference": "urn:uuid:dba58ad9-6a83-cce9-e932-2374451911f4" }, { "reference": "urn:uuid:112a53e8-58f9-7e88-bf8c-587cf5ab8566" }, { "reference": "urn:uuid:45a2fae3-0598-bf00-4dc2-93c348987cc0" }, { "reference": "urn:uuid:06ef0c7b-1d13-71f0-4cb7-400525e9c340" }, { "reference": "urn:uuid:521bc207-a5f2-4b34-9d92-66a0544480f6" }, { "reference": "urn:uuid:750ed05b-66cd-613c-c3f5-758df8fcecb4" }, { "reference": "urn:uuid:0589b4f4-ed12-8bfb-10c0-867d6f59d82e" }, { "reference": "urn:uuid:7531b37a-76d9-1939-ddad-6162d4fa7f7d" }, { "reference": "urn:uuid:7f1599ee-46e4-cae3-fec6-d8fc452c83a7" }, { "reference": "urn:uuid:bf61a020-6ce8-0b40-a2f7-4fecc09fc680" }, { "reference": "urn:uuid:b0082764-2060-5d1b-0d27-843c037e5836" }, { "reference": "urn:uuid:47b8e2db-94af-98b5-58b0-bb36eba7ff5d" }, { "reference": "urn:uuid:c7ebbff8-5257-83fd-6a6b-47940995ae47" }, { "reference": "urn:uuid:ca93533e-965a-39fe-209c-cdd8de6e7999" }, { "reference": "urn:uuid:2f02cd4e-21f5-1598-2a5b-eafdf05ce41a" }, { "reference": "urn:uuid:69381c91-1a2e-df2f-6e37-2f972225c443" }, { "reference": "urn:uuid:17a8b294-bdd2-e31d-59ce-c84ce514da05" }, { "reference": "urn:uuid:61a50124-5509-c3b3-d9fb-febbafb8c380" }, { "reference": "urn:uuid:6d72f0cb-a9bb-bc55-2b85-51007dc23816" }, { "reference": "urn:uuid:b9b7ed79-7695-21fb-65f0-b92412d273f3" }, { "reference": "urn:uuid:f919801c-952b-ffdf-394b-367b2a1d0a29" }, { "reference": "urn:uuid:b1d56d63-4eae-570d-85e2-9d5068efb537" }, { "reference": "urn:uuid:8345370d-6a26-e32d-f42a-beae3d085d7b" }, { "reference": "urn:uuid:1fe845c8-0004-d9d0-0cd1-987d715bde8c" }, { "reference": "urn:uuid:5516be19-afbd-e16a-7a80-a27f40f1c59d" }, { "reference": "urn:uuid:18ff14c5-1a57-7868-e781-45dc0bf661ec" }, { "reference": "urn:uuid:d8e9e6a3-c3c7-512a-7522-28b0b734a7f5" }, { "reference": "urn:uuid:1c879349-d9b6-0106-e456-cf346f8a7a79" }, { "reference": "urn:uuid:42ed70c2-fe4b-04a6-f3ee-57242e564003" }, { "reference": "urn:uuid:6130af7e-4bcc-45bf-e8f2-2254883b2188" }, { "reference": "urn:uuid:177462d3-ec8a-4760-1326-fb7e4ca2cfa8" }, { "reference": "urn:uuid:e5c903e0-33c0-dac6-ef49-5dbb2148e1f9" }, { "reference": "urn:uuid:b1dceea6-e4a7-f699-9944-490844ad92f4" }, { "reference": "urn:uuid:41483aaf-9215-68e8-b264-9a22ca5bbeec" }, { "reference": "urn:uuid:05294d19-d57c-59fd-5f04-3aa1dcaf637d" }, { "reference": "urn:uuid:d025fdee-caa3-63d7-c6bc-236eb52bb4fc" }, { "reference": "urn:uuid:23cfbc21-6613-1372-3035-21505fcc93ce" }, { "reference": "urn:uuid:ca56dab3-8857-b83e-7418-25004cc9c43d" }, { "reference": "urn:uuid:081877d5-e9df-fbff-9927-8a8943f145ff" }, { "reference": "urn:uuid:1284c2de-cf83-5f3f-ed71-ef0f78eb7198" }, { "reference": "urn:uuid:d7ce498a-5cce-ac42-1863-1861c630318e" }, { "reference": "urn:uuid:2014bc36-e4e3-75bc-9b61-b1918ef63dc1" }, { "reference": "urn:uuid:93a394dd-fa6d-c09c-2ba5-328cd2ee33cd" }, { "reference": "urn:uuid:e61d8353-a100-43d8-34f9-b5de7f835782" }, { "reference": "urn:uuid:f985b32b-fbce-ca8d-7541-c8fa86881396" }, { "reference": "urn:uuid:0fcf2e53-9a00-5722-5b60-2897f8d02022" }, { "reference": "urn:uuid:7742726b-3f3d-a826-f684-edf2741dbc7c" }, { "reference": "urn:uuid:16570ce9-6680-66bf-9610-b07e755c6fb3" }, { "reference": "urn:uuid:fbf07f23-3de6-8c40-6fcb-06e24671824b" }, { "reference": "urn:uuid:9473987b-ee4e-5edc-0bbe-0dc49b723014" }, { "reference": "urn:uuid:b0835835-6a40-07c9-0c8c-4d11d477fcdc" }, { "reference": "urn:uuid:a9b8edeb-dac6-3bb5-6d07-7683838fc539" }, { "reference": "urn:uuid:0265d71e-5152-78af-bd72-871048ba3f55" }, { "reference": "urn:uuid:c686eebc-e6f2-9284-be6f-5c3801331f87" }, { "reference": "urn:uuid:e1902ea8-fcb0-ccd7-23f7-2bdb13a25863" }, { "reference": "urn:uuid:659b24cb-b82f-e589-e38f-e1f9637c17f6" }, { "reference": "urn:uuid:a219317c-c308-c0cc-7274-d4405cc165b8" }, { "reference": "urn:uuid:673cbccc-85ef-95e5-9752-e97d437f26ee" }, { "reference": "urn:uuid:c12fed1f-af78-a434-de5b-444edb0e854f" }, { "reference": "urn:uuid:e1e7b2ff-1f04-b471-3ec9-651d47a29bea" }, { "reference": "urn:uuid:8dfb3e2d-161d-ea38-2154-f7494f098e46" }, { "reference": "urn:uuid:ac151ed0-491c-9604-3eeb-5224bd03915f" }, { "reference": "urn:uuid:fc4d3f1b-d049-eac5-5fd5-acd6533f4353" }, { "reference": "urn:uuid:53b1454b-b977-b74c-c68e-a60f0ac6e980" }, { "reference": "urn:uuid:5308d529-ac05-bd10-c90d-e7e48a290bad" }, { "reference": "urn:uuid:3a5e26af-af5a-0b8e-0044-99f9c6f026e3" }, { "reference": "urn:uuid:8313f3ab-ab7c-6e28-8654-aa78760b3eaf" }, { "reference": "urn:uuid:87b724ef-f1f1-e95c-dde4-3750a4f34885" }, { "reference": "urn:uuid:192c0ac8-220c-e4fb-2d8a-fb2ab704bf41" }, { "reference": "urn:uuid:c1e6d036-1145-32a1-c0ba-d9b60b0eca27" }, { "reference": "urn:uuid:62758dd7-6da7-3911-0de0-79f403be5113" }, { "reference": "urn:uuid:6a593244-0118-c7c4-94d9-6f8ca05c5bec" }, { "reference": "urn:uuid:c02427d5-2456-a73c-0a74-83a7d09082cb" }, { "reference": "urn:uuid:4efec9a2-09e3-ffe9-cfb4-b1fa25ac9734" }, { "reference": "urn:uuid:5e05f0c6-a056-8f8d-3353-d20a4ce505cf" }, { "reference": "urn:uuid:40cc8740-c03b-dd39-eadc-fb269716537f" }, { "reference": "urn:uuid:199a365f-8121-ef83-6728-1e611ed0c821" }, { "reference": "urn:uuid:a2a1ce9e-61d9-b907-a959-1268aeb1957d" }, { "reference": "urn:uuid:65dce252-b788-c5af-d064-219c7937931b" }, { "reference": "urn:uuid:ee2da33e-8c21-1efe-c91b-2d2364ff9f18" }, { "reference": "urn:uuid:5671c01f-7b74-48bb-5932-68723ae84f0d" }, { "reference": "urn:uuid:cb005a49-5ccd-29c3-54ae-4cabc3ec2555" }, { "reference": "urn:uuid:d5e1e25f-7eb3-0dbc-236f-ca611c61e65b" }, { "reference": "urn:uuid:f34a6a6a-d81c-bcd8-8d14-bceca4b23a25" }, { "reference": "urn:uuid:b6d52ff7-5011-a9c6-79d6-bda503456dca" }, { "reference": "urn:uuid:fb891275-26cc-f6c2-2cac-02e29700dc33" }, { "reference": "urn:uuid:dae77ee1-543d-a417-3d7d-614c8b86f45a" }, { "reference": "urn:uuid:dff71cca-afb0-3359-b801-b77285827b19" }, { "reference": "urn:uuid:94f1d563-78f2-4cd6-9f88-568916a11f99" }, { "reference": "urn:uuid:5dd23003-fa78-6918-d468-4858ae81b605" }, { "reference": "urn:uuid:08481091-1386-f908-a008-429f5890b08d" }, { "reference": "urn:uuid:d17d17c7-c823-8b78-aa1b-6555b0252927" }, { "reference": "urn:uuid:00672ec7-bd8d-213a-1ebd-9f29b4926976" }, { "reference": "urn:uuid:3ed8418e-f903-a96f-7a07-28f30e089c21" }, { "reference": "urn:uuid:c639034c-6020-6281-2e4b-9d274d4c932b" }, { "reference": "urn:uuid:66c9d4ee-9e64-f8aa-c84f-202f3333d013" }, { "reference": "urn:uuid:fae6674c-92b8-2e27-8b12-454e928104e7" }, { "reference": "urn:uuid:9aede761-8593-f9f6-0259-9d8edef897f7" }, { "reference": "urn:uuid:b7116f85-a51a-087f-df00-1ec3fe675960" }, { "reference": "urn:uuid:c8d1a932-ee3f-cc54-f3a2-1d19570087f1" }, { "reference": "urn:uuid:89cc4a74-97fe-64b5-ca61-194c015fea00" }, { "reference": "urn:uuid:30d3e235-1d25-8134-3cfe-3c39b39c3c7f" }, { "reference": "urn:uuid:bfce9270-56aa-925b-ca43-5e20c85b4760" }, { "reference": "urn:uuid:b9dcb665-9c62-be97-1567-cab99f319604" }, { "reference": "urn:uuid:99396b50-da30-c8a7-7d10-b6d3efb457ed" }, { "reference": "urn:uuid:b35f5f32-733d-c7a5-96f7-08f145aea8a3" }, { "reference": "urn:uuid:8eed5019-e3e7-4d53-b280-e56266f0ffb6" }, { "reference": "urn:uuid:6c3f57df-b374-9dc4-0f74-a41b92840693" }, { "reference": "urn:uuid:06886441-b092-0fe8-fccc-9958c781d446" }, { "reference": "urn:uuid:980a07e0-2a26-e525-1533-6f00eb5cec08" }, { "reference": "urn:uuid:e91742c4-3df9-3fcc-3faf-5e1e37ee58a4" }, { "reference": "urn:uuid:ee3b4adb-462a-f551-a170-59b7f935f3e8" }, { "reference": "urn:uuid:b278c4c7-9dcb-9cea-5f70-e2c4b9c34300" }, { "reference": "urn:uuid:50592a36-a297-9d3b-b01f-670cbed92608" }, { "reference": "urn:uuid:c66c5d59-a14f-82b3-e5aa-0da404cdf8f3" }, { "reference": "urn:uuid:0d165fb2-fd6a-fb94-6b9f-206d8e3cc5ff" }, { "reference": "urn:uuid:6003d46a-e414-8d25-cb4a-b11a955a9587" }, { "reference": "urn:uuid:743264ac-373b-b771-7ec8-3524146ad5aa" }, { "reference": "urn:uuid:15ad793e-a0e9-581a-f02b-120e1eb82b3e" }, { "reference": "urn:uuid:ce2a6a75-b4f6-e666-2eed-29f07494de04" }, { "reference": "urn:uuid:225d4a4a-ccf4-dc9d-851b-2c334479541d" }, { "reference": "urn:uuid:95cdacc9-49fd-e297-ceee-ae9971ca50bd" }, { "reference": "urn:uuid:5366da41-12aa-c93e-714c-7a65ac416ab6" }, { "reference": "urn:uuid:9c21995d-d84d-a83e-93dc-7a399101af01" }, { "reference": "urn:uuid:ea0515f9-78e6-81c0-5ce7-cf714fbfb506" }, { "reference": "urn:uuid:0652b576-d388-1227-7e12-846a6af5aac4" }, { "reference": "urn:uuid:d69bda99-8613-3e25-cad1-53aea97991ab" }, { "reference": "urn:uuid:202d4787-a131-57e3-644d-84b98aac1e30" }, { "reference": "urn:uuid:065c05d2-3246-2c4b-1df9-363fefd85445" }, { "reference": "urn:uuid:63decc33-9a03-b37d-42ae-6d4e2ffa1fb3" }, { "reference": "urn:uuid:dabaddaf-8f25-ec7c-bec6-35ed9af04514" }, { "reference": "urn:uuid:d630abc2-fadb-f803-79e6-199a8c728739" }, { "reference": "urn:uuid:15c8225c-e624-f38f-bc37-9c0dfdddc5be" }, { "reference": "urn:uuid:e9214ebf-ee1c-d4cb-e688-4f73a3f7ec50" }, { "reference": "urn:uuid:ba4d084d-7bd4-c053-1b1f-4342fbd3e44d" }, { "reference": "urn:uuid:dfa28ba0-a2bd-5247-eb73-cd5b36e77f61" }, { "reference": "urn:uuid:dc6b7f71-ee46-2268-df3a-56de4c5a1804" }, { "reference": "urn:uuid:382d3f39-2aba-4e2f-1cb0-5f36c005d099" }, { "reference": "urn:uuid:caec45e1-3c66-6098-396f-f2ffe2942ea6" }, { "reference": "urn:uuid:c13a224e-8c55-e79b-37f5-853f2c02c7a2" }, { "reference": "urn:uuid:e40cb505-3137-25ae-1f16-7098fa7e716e" }, { "reference": "urn:uuid:cf8512aa-6df9-8d90-a402-52804c37ea1d" }, { "reference": "urn:uuid:cc7d1347-cf7e-8a4e-2391-63950a70bad2" }, { "reference": "urn:uuid:62a3f348-1235-1f62-b757-fc94ffabb57a" }, { "reference": "urn:uuid:c45cedf8-7e05-a30c-790d-b09e1e4f0a78" }, { "reference": "urn:uuid:54a61cd8-e71c-014f-bf7c-1b8e6a1b93b0" }, { "reference": "urn:uuid:f7d56ebe-b37a-4ed7-f53c-6f726955665c" }, { "reference": "urn:uuid:35cb2694-fa99-072e-2545-cdbd6fbaef7e" }, { "reference": "urn:uuid:72b96a36-e036-a424-3581-195c7f92eab2" }, { "reference": "urn:uuid:b90d96fb-cb17-a207-64b9-0d5bb8b593cf" }, { "reference": "urn:uuid:3e84d189-c353-c23e-f6da-e3b96352d965" }, { "reference": "urn:uuid:761872ac-32dd-8d7a-4e9c-da03cfa058c1" }, { "reference": "urn:uuid:238d20c0-7d11-43f3-41a1-8f564a199b6f" }, { "reference": "urn:uuid:69cf4603-e492-3d98-fda5-02d011ecb90f" }, { "reference": "urn:uuid:258c1cb9-c548-427c-3f6d-7d1b4a0b096f" }, { "reference": "urn:uuid:baabf7b9-5fa4-01a3-f9d8-a440aaf5a634" }, { "reference": "urn:uuid:13e78b99-65d2-49f3-df3a-b03bd96485d7" }, { "reference": "urn:uuid:c0d0e1ee-9c8a-acbf-8204-c57c9fba72b2" }, { "reference": "urn:uuid:65167a89-d8a7-ebd1-3e29-a8324dbf15de" }, { "reference": "urn:uuid:4f8298ab-10f8-7845-7a17-033dbd4b5c64" }, { "reference": "urn:uuid:6d20a921-3515-5bda-f68c-10f277df3929" }, { "reference": "urn:uuid:e8c245dd-3eab-b6f5-d5cb-dac0be327c97" }, { "reference": "urn:uuid:88985ec5-21d1-9aeb-5a87-403a1509027d" }, { "reference": "urn:uuid:4bf59bc8-5f57-c47f-0beb-f9323b815a33" }, { "reference": "urn:uuid:2f0c4c32-7b1d-faa9-3965-074058e34d02" }, { "reference": "urn:uuid:7d23e1f7-548d-f1fa-1094-2d2c26bae4c3" }, { "reference": "urn:uuid:a8e75362-c3d8-c548-45c8-030b07d90bfd" }, { "reference": "urn:uuid:17bfe5bc-ff2d-8dd6-8728-4a781a978623" }, { "reference": "urn:uuid:23246217-cd0e-5291-fe3c-98472f8fc7f1" }, { "reference": "urn:uuid:83f20cc8-de40-da6f-e3ef-a2d105a83ef2" }, { "reference": "urn:uuid:89371e31-0bc0-d47b-d0eb-9b8779a7aef0" }, { "reference": "urn:uuid:abfcc227-7485-ed63-6c85-27244e631fbc" }, { "reference": "urn:uuid:54ed123e-0b00-eda3-545e-b7a470b278f8" }, { "reference": "urn:uuid:8c4185e3-064b-620d-5834-ec3cfc6d7ed6" }, { "reference": "urn:uuid:f7c60f9d-5c62-441f-1dcd-1074f8f9602d" }, { "reference": "urn:uuid:6e7d1323-a3a4-736a-b7a3-aec6298adf33" }, { "reference": "urn:uuid:1ac19409-d445-17d6-2f67-8c2f36614f96" }, { "reference": "urn:uuid:830b3640-22c4-2c9c-3e6e-9e4944e43313" }, { "reference": "urn:uuid:93b8c6f8-854b-4e3b-4385-4e3f93bd14f5" }, { "reference": "urn:uuid:e399ea1a-6e3b-af04-b426-b81371837841" }, { "reference": "urn:uuid:12d8e6c0-1536-ae35-3761-6719f0243bd5" }, { "reference": "urn:uuid:96848b4e-a0f7-d22f-e067-526ebe084e12" }, { "reference": "urn:uuid:c3db7294-8211-f14b-2234-40e9eaeb6d93" }, { "reference": "urn:uuid:6cfd6a2a-48e1-2844-ad46-7b2afc97035f" }, { "reference": "urn:uuid:4307f1a7-a636-24cb-41c7-5db8e8283b0e" }, { "reference": "urn:uuid:d4cb773f-8c88-1599-906c-4a6d4065e6c2" }, { "reference": "urn:uuid:dfbfe4c2-432c-16df-89ae-ec746aa0d6c2" }, { "reference": "urn:uuid:523134fb-b81d-639f-305c-1c285ae2b821" }, { "reference": "urn:uuid:edb54751-fcf2-bb2c-371c-b306adb560cd" }, { "reference": "urn:uuid:6cf45ac2-f343-6ac6-8221-5d162ea1104c" }, { "reference": "urn:uuid:df1051cd-4d63-50ca-916b-867432e9bc09" }, { "reference": "urn:uuid:826783b3-c2b7-adda-caef-8551719087dc" } ], "recorded": "2023-06-27T00:11:11.671-04:00", "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|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "onBehalfOf": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } }, { "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|9999952291", "display": "Dr. Kayce253 Ondricka197" }, "onBehalfOf": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9b8a7a25-b923-3710-9f3c-d42919a3f54f", "display": "COMPASSIONATE CARE INTERNAL MEDICINE, LLC" } } ] }, "request": { "method": "POST", "url": "Provenance" } } ] }