diff --git "a/output/fhir/Herbert830_Rowe323_56a52527-d782-5736-2951-2ee1dcfb6a92.json" "b/output/fhir/Herbert830_Rowe323_56a52527-d782-5736-2951-2ee1dcfb6a92.json" new file mode 100644--- /dev/null +++ "b/output/fhir/Herbert830_Rowe323_56a52527-d782-5736-2951-2ee1dcfb6a92.json" @@ -0,0 +1,71636 @@ +{ + "resourceType": "Bundle", + "type": "transaction", + "entry": [ { + "fullUrl": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "resource": { + "resourceType": "Patient", + "id": "56a52527-d782-5736-2951-2ee1dcfb6a92", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient" ] + }, + "text": { + "status": "generated", + "div": "
Generated by Synthea.Version identifier: master-branch-latest\n . Person seed: 3324747330091722215 Population seed: 1747236424530
" + }, + "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": "Eneida722 Wintheiser220" + }, { + "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex", + "valueCode": "M" + }, { + "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace", + "valueAddress": { + "city": "South Yarmouth", + "state": "Massachusetts", + "country": "US" + } + }, { + "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years", + "valueDecimal": 0.49116249700717485 + }, { + "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years", + "valueDecimal": 43.508837502992826 + } ], + "identifier": [ { + "system": "https://github.com/synthetichealth/synthea", + "value": "56a52527-d782-5736-2951-2ee1dcfb6a92" + }, { + "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": "56a52527-d782-5736-2951-2ee1dcfb6a92" + }, { + "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": "999-59-7809" + }, { + "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": "S99956823" + }, { + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v2-0203", + "code": "PPN", + "display": "Passport Number" + } ], + "text": "Passport Number" + }, + "system": "http://hl7.org/fhir/sid/passport-USA", + "value": "X88588426X" + } ], + "name": [ { + "use": "official", + "family": "Rowe323", + "given": [ "Herbert830", "Tyron580" ], + "prefix": [ "Mr." ] + } ], + "telecom": [ { + "system": "phone", + "value": "555-119-3065", + "use": "home" + } ], + "gender": "male", + "birthDate": "1980-02-24", + "address": [ { + "extension": [ { + "url": "http://hl7.org/fhir/StructureDefinition/geolocation", + "extension": [ { + "url": "latitude", + "valueDecimal": 42.14670564635528 + }, { + "url": "longitude", + "valueDecimal": -73.3556000273078 + } ] + } ], + "line": [ "627 Ullrich Dam Unit 88" ], + "city": "Great Barrington", + "state": "MA", + "postalCode": "01230", + "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:eec4c9ac-83b4-a4b9-3efb-d34f95eafc65", + "resource": { + "resourceType": "Encounter", + "id": "eec4c9ac-83b4-a4b9-3efb-d34f95eafc65", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "eec4c9ac-83b4-a4b9-3efb-d34f95eafc65" + } ], + "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 (procedure)" + } ], + "text": "Encounter for problem (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "1981-06-25T04:41:58+01:00", + "end": "1981-06-25T04:56:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "1981-06-25T04:41:58+01:00", + "end": "1981-06-25T04:56:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "735029006", + "display": "Shellfish (substance)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:8661f003-b6e9-fef1-3fa9-377437e7ff13", + "resource": { + "resourceType": "CareTeam", + "id": "8661f003-b6e9-fef1-3fa9-377437e7ff13", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] + }, + "status": "active", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:eec4c9ac-83b4-a4b9-3efb-d34f95eafc65" + }, + "period": { + "start": "1981-06-25T04:41:58+01:00" + }, + "participant": [ { + "role": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "116154003", + "display": "Patient" + } ], + "text": "Patient" + } ], + "member": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + } + }, { + "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|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + }, { + "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|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "managingOrganization": [ { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } ] + }, + "request": { + "method": "POST", + "url": "CareTeam" + } + }, { + "fullUrl": "urn:uuid:0487631b-4dea-ad9b-867d-5dccf649867d", + "resource": { + "resourceType": "CarePlan", + "id": "0487631b-4dea-ad9b-867d-5dccf649867d", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] + }, + "text": { + "status": "generated", + "div": "
Care Plan for Self-care interventions (procedure).
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": "384758001", + "display": "Self-care interventions (procedure)" + } ], + "text": "Self-care interventions (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:eec4c9ac-83b4-a4b9-3efb-d34f95eafc65" + }, + "period": { + "start": "1981-06-25T04:41:58+01:00" + }, + "careTeam": [ { + "reference": "urn:uuid:8661f003-b6e9-fef1-3fa9-377437e7ff13" + } ], + "activity": [ { + "detail": { + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "409002", + "display": "Food allergy diet (finding)" + } ], + "text": "Food allergy diet (finding)" + }, + "status": "in-progress", + "location": { + "display": "FAIRVIEW HOSPITAL" + } + } + }, { + "detail": { + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "58332002", + "display": "Allergy education (procedure)" + } ], + "text": "Allergy education (procedure)" + }, + "status": "in-progress", + "location": { + "display": "FAIRVIEW HOSPITAL" + } + } + }, { + "detail": { + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "58332002", + "display": "Allergy education (procedure)" + } ], + "text": "Allergy education (procedure)" + }, + "status": "in-progress", + "location": { + "display": "FAIRVIEW HOSPITAL" + } + } + } ] + }, + "request": { + "method": "POST", + "url": "CarePlan" + } + }, { + "fullUrl": "urn:uuid:b79ff204-0723-e17c-6fdf-c84fefd81320", + "resource": { + "resourceType": "DiagnosticReport", + "id": "b79ff204-0723-e17c-6fdf-c84fefd81320", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:eec4c9ac-83b4-a4b9-3efb-d34f95eafc65" + }, + "effectiveDateTime": "1981-06-25T04:41:58+01:00", + "issued": "1981-06-25T04:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:05b5c76b-b54d-ce6f-a742-e52db4002db4", + "resource": { + "resourceType": "DocumentReference", + "id": "05b5c76b-b54d-ce6f-a742-e52db4002db4", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:b79ff204-0723-e17c-6fdf-c84fefd81320" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "1981-06-25T04:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:eec4c9ac-83b4-a4b9-3efb-d34f95eafc65" + } ], + "period": { + "start": "1981-06-25T04:41:58+01:00", + "end": "1981-06-25T04:56:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:587e2055-a4ca-f06e-aa62-438a62c0a68f", + "resource": { + "resourceType": "Claim", + "id": "587e2055-a4ca-f06e-aa62-438a62c0a68f", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "1981-06-25T04:41:58+01:00", + "end": "1981-06-25T04:56:58+01:00" + }, + "created": "1981-06-25T04:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "NO_INSURANCE" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185347001", + "display": "Encounter for problem (procedure)" + } ], + "text": "Encounter for problem (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:eec4c9ac-83b4-a4b9-3efb-d34f95eafc65" + } ] + } ], + "total": { + "value": 85.55, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:e5ffd87a-0845-d6bd-e200-1bec9ed4b7bf", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "e5ffd87a-0845-d6bd-e200-1bec9ed4b7bf", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "NO_INSURANCE" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "NO_INSURANCE" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "587e2055-a4ca-f06e-aa62-438a62c0a68f" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "1981-06-25T04:56:58+01:00", + "end": "1982-06-25T04:56:58+01:00" + }, + "created": "1981-06-25T04:56:58+01:00", + "insurer": { + "display": "NO_INSURANCE" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:587e2055-a4ca-f06e-aa62-438a62c0a68f" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "NO_INSURANCE" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for problem (procedure)" + }, + "servicedPeriod": { + "start": "1981-06-25T04:41:58+01:00", + "end": "1981-06-25T04:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:eec4c9ac-83b4-a4b9-3efb-d34f95eafc65" + } ] + } ], + "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:8dfb273f-2efc-9d92-602f-7717d96f41f7", + "resource": { + "resourceType": "Encounter", + "id": "8dfb273f-2efc-9d92-602f-7717d96f41f7", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "8dfb273f-2efc-9d92-602f-7717d96f41f7" + } ], + "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 (procedure)" + } ], + "text": "Encounter for problem (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "1981-07-09T12:41:58+01:00", + "end": "1981-07-09T13:20:59+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "1981-07-09T12:41:58+01:00", + "end": "1981-07-09T13:20:59+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "609328004", + "display": "Allergic disposition (finding)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:c536ec48-ffaa-f1a2-cb29-61d08ac73513", + "resource": { + "resourceType": "AllergyIntolerance", + "id": "c536ec48-ffaa-f1a2-cb29-61d08ac73513", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance" ] + }, + "clinicalStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", + "code": "active" + } ] + }, + "verificationStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", + "code": "confirmed" + } ] + }, + "type": "allergy", + "category": [ "environment" ], + "criticality": "low", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "609328004", + "display": "Allergic disposition (finding)" + } ], + "text": "Allergic disposition (finding)" + }, + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "recordedDate": "1981-07-09T12:41:58+01:00" + }, + "request": { + "method": "POST", + "url": "AllergyIntolerance" + } + }, { + "fullUrl": "urn:uuid:c2cd1eee-71db-1a43-45bc-bd78486bb314", + "resource": { + "resourceType": "AllergyIntolerance", + "id": "c2cd1eee-71db-1a43-45bc-bd78486bb314", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance" ] + }, + "clinicalStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", + "code": "active" + } ] + }, + "verificationStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", + "code": "confirmed" + } ] + }, + "type": "allergy", + "category": [ "medication" ], + "criticality": "low", + "code": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "1191", + "display": "Aspirin" + } ], + "text": "Aspirin" + }, + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "recordedDate": "1981-07-09T12:41:58+01:00" + }, + "request": { + "method": "POST", + "url": "AllergyIntolerance" + } + }, { + "fullUrl": "urn:uuid:a50f7d14-9eed-6c06-31ee-bc1d44887a33", + "resource": { + "resourceType": "AllergyIntolerance", + "id": "a50f7d14-9eed-6c06-31ee-bc1d44887a33", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance" ] + }, + "clinicalStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", + "code": "active" + } ] + }, + "verificationStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", + "code": "confirmed" + } ] + }, + "type": "allergy", + "category": [ "medication" ], + "criticality": "low", + "code": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "7984", + "display": "Penicillin V" + } ], + "text": "Penicillin V" + }, + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "recordedDate": "1981-07-09T12:41:58+01:00", + "reaction": [ { + "manifestation": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "247472004", + "display": "Wheal (finding)" + } ], + "text": "Wheal (finding)" + } ] + } ] + }, + "request": { + "method": "POST", + "url": "AllergyIntolerance" + } + }, { + "fullUrl": "urn:uuid:28715b7b-0738-cd90-c182-5276ee8bcb03", + "resource": { + "resourceType": "AllergyIntolerance", + "id": "28715b7b-0738-cd90-c182-5276ee8bcb03", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance" ] + }, + "clinicalStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", + "code": "active" + } ] + }, + "verificationStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", + "code": "confirmed" + } ] + }, + "type": "allergy", + "category": [ "food" ], + "criticality": "low", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "735029006", + "display": "Shellfish (substance)" + } ], + "text": "Shellfish (substance)" + }, + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "recordedDate": "1981-07-09T12:41:58+01:00", + "reaction": [ { + "manifestation": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "267036007", + "display": "Dyspnea (finding)" + } ], + "text": "Dyspnea (finding)" + } ] + }, { + "manifestation": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "271807003", + "display": "Eruption of skin (disorder)" + } ], + "text": "Eruption of skin (disorder)" + } ] + }, { + "manifestation": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "39579001", + "display": "Anaphylaxis (disorder)" + } ], + "text": "Anaphylaxis (disorder)" + } ] + } ] + }, + "request": { + "method": "POST", + "url": "AllergyIntolerance" + } + }, { + "fullUrl": "urn:uuid:c0c098b2-5fff-27e6-73e3-956838d3e4be", + "resource": { + "resourceType": "MedicationRequest", + "id": "c0c098b2-5fff-27e6-73e3-956838d3e4be", + "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": "477045", + "display": "Chlorpheniramine Maleate 2 MG/ML Oral Solution" + } ], + "text": "Chlorpheniramine Maleate 2 MG/ML Oral Solution" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:8dfb273f-2efc-9d92-602f-7717d96f41f7" + }, + "authoredOn": "1981-07-09T13:20:59+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + }, + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:682f6169-836d-0508-8464-3b6b5026589d", + "resource": { + "resourceType": "Claim", + "id": "682f6169-836d-0508-8464-3b6b5026589d", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "1981-07-09T12:41:58+01:00", + "end": "1981-07-09T13:20:59+01:00" + }, + "created": "1981-07-09T13:20:59+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:c0c098b2-5fff-27e6-73e3-956838d3e4be" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "NO_INSURANCE" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "477045", + "display": "Chlorpheniramine Maleate 2 MG/ML Oral Solution" + } ], + "text": "Chlorpheniramine Maleate 2 MG/ML Oral Solution" + }, + "encounter": [ { + "reference": "urn:uuid:8dfb273f-2efc-9d92-602f-7717d96f41f7" + } ] + } ], + "total": { + "value": 152.88, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:1b65f4a1-45bc-d267-a6cd-3c11c6bbfa59", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "1b65f4a1-45bc-d267-a6cd-3c11c6bbfa59", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "NO_INSURANCE" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "NO_INSURANCE" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "682f6169-836d-0508-8464-3b6b5026589d" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "1981-07-09T13:20:59+01:00", + "end": "1982-07-09T13:20:59+01:00" + }, + "created": "1981-07-09T13:20:59+01:00", + "insurer": { + "display": "NO_INSURANCE" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:682f6169-836d-0508-8464-3b6b5026589d" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "NO_INSURANCE" + } + } ], + "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": "477045", + "display": "Chlorpheniramine Maleate 2 MG/ML Oral Solution" + } ], + "text": "Chlorpheniramine Maleate 2 MG/ML Oral Solution" + }, + "servicedPeriod": { + "start": "1981-07-09T12:41:58+01:00", + "end": "1981-07-09T13:20:59+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:8dfb273f-2efc-9d92-602f-7717d96f41f7" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 152.88, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:10612a98-c7d6-d133-def0-0b9821067403", + "resource": { + "resourceType": "DiagnosticReport", + "id": "10612a98-c7d6-d133-def0-0b9821067403", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:8dfb273f-2efc-9d92-602f-7717d96f41f7" + }, + "effectiveDateTime": "1981-07-09T12:41:58+01:00", + "issued": "1981-07-09T12:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:6f613325-67db-7d35-ec77-b959dee377fe", + "resource": { + "resourceType": "DocumentReference", + "id": "6f613325-67db-7d35-ec77-b959dee377fe", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:10612a98-c7d6-d133-def0-0b9821067403" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "1981-07-09T12:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:8dfb273f-2efc-9d92-602f-7717d96f41f7" + } ], + "period": { + "start": "1981-07-09T12:41:58+01:00", + "end": "1981-07-09T13:20:59+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:08c80e32-1ffd-bc81-db4b-a497735c8018", + "resource": { + "resourceType": "Claim", + "id": "08c80e32-1ffd-bc81-db4b-a497735c8018", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "1981-07-09T12:41:58+01:00", + "end": "1981-07-09T13:20:59+01:00" + }, + "created": "1981-07-09T13:20:59+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "NO_INSURANCE" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185347001", + "display": "Encounter for problem (procedure)" + } ], + "text": "Encounter for problem (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:8dfb273f-2efc-9d92-602f-7717d96f41f7" + } ] + } ], + "total": { + "value": 516.95, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:ab61f518-0b8a-353f-54a9-3c888c895ca3", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "ab61f518-0b8a-353f-54a9-3c888c895ca3", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "NO_INSURANCE" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "NO_INSURANCE" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "08c80e32-1ffd-bc81-db4b-a497735c8018" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "1981-07-09T13:20:59+01:00", + "end": "1982-07-09T13:20:59+01:00" + }, + "created": "1981-07-09T13:20:59+01:00", + "insurer": { + "display": "NO_INSURANCE" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:08c80e32-1ffd-bc81-db4b-a497735c8018" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "NO_INSURANCE" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for problem (procedure)" + }, + "servicedPeriod": { + "start": "1981-07-09T12:41:58+01:00", + "end": "1981-07-09T13:20:59+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:8dfb273f-2efc-9d92-602f-7717d96f41f7" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 516.95, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:0b121219-cbfd-f536-8232-1a33c5e3ea58", + "resource": { + "resourceType": "Encounter", + "id": "0b121219-cbfd-f536-8232-1a33c5e3ea58", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "0b121219-cbfd-f536-8232-1a33c5e3ea58" + } ], + "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 (procedure)" + } ], + "text": "Encounter for symptom (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "1984-12-26T08:41:58+01:00", + "end": "1984-12-26T08:56:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "1984-12-26T08:41:58+01:00", + "end": "1984-12-26T08:56:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:93ca7c88-5ce2-cb5d-98d4-b6c3e0edf373", + "resource": { + "resourceType": "CareTeam", + "id": "93ca7c88-5ce2-cb5d-98d4-b6c3e0edf373", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] + }, + "status": "active", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0b121219-cbfd-f536-8232-1a33c5e3ea58" + }, + "period": { + "start": "1984-12-26T08:41:58+01:00" + }, + "participant": [ { + "role": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "116154003", + "display": "Patient" + } ], + "text": "Patient" + } ], + "member": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + } + }, { + "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|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + }, { + "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|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "managingOrganization": [ { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } ] + }, + "request": { + "method": "POST", + "url": "CareTeam" + } + }, { + "fullUrl": "urn:uuid:b04268c4-120e-3963-8f3e-d22bea9178a2", + "resource": { + "resourceType": "CarePlan", + "id": "b04268c4-120e-3963-8f3e-d22bea9178a2", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] + }, + "text": { + "status": "generated", + "div": "
Care Plan for Asthma self management (regime/therapy).
Care plan is meant to treat Childhood asthma (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": "699728000", + "display": "Asthma self management (regime/therapy)" + } ], + "text": "Asthma self management (regime/therapy)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0b121219-cbfd-f536-8232-1a33c5e3ea58" + }, + "period": { + "start": "1984-12-26T08:41:58+01:00" + }, + "careTeam": [ { + "reference": "urn:uuid:93ca7c88-5ce2-cb5d-98d4-b6c3e0edf373" + } ], + "activity": [ { + "detail": { + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "710818004", + "display": "Inhaled steroid therapy (procedure)" + } ], + "text": "Inhaled steroid therapy (procedure)" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "status": "in-progress", + "location": { + "display": "FAIRVIEW HOSPITAL" + } + } + }, { + "detail": { + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "708409001", + "display": "Home nebulizer therapy (procedure)" + } ], + "text": "Home nebulizer therapy (procedure)" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "status": "in-progress", + "location": { + "display": "FAIRVIEW HOSPITAL" + } + } + }, { + "detail": { + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "229298005", + "display": "Breathing control (regime/therapy)" + } ], + "text": "Breathing control (regime/therapy)" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "status": "in-progress", + "location": { + "display": "FAIRVIEW HOSPITAL" + } + } + } ] + }, + "request": { + "method": "POST", + "url": "CarePlan" + } + }, { + "fullUrl": "urn:uuid:88843827-4b86-e957-1765-37807b29ba1e", + "resource": { + "resourceType": "DiagnosticReport", + "id": "88843827-4b86-e957-1765-37807b29ba1e", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0b121219-cbfd-f536-8232-1a33c5e3ea58" + }, + "effectiveDateTime": "1984-12-26T08:41:58+01:00", + "issued": "1984-12-26T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:0ee528f3-3c9b-3115-256b-5d6a4495fa92", + "resource": { + "resourceType": "DocumentReference", + "id": "0ee528f3-3c9b-3115-256b-5d6a4495fa92", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:88843827-4b86-e957-1765-37807b29ba1e" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "1984-12-26T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:0b121219-cbfd-f536-8232-1a33c5e3ea58" + } ], + "period": { + "start": "1984-12-26T08:41:58+01:00", + "end": "1984-12-26T08:56:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:7fd0436e-8f09-9730-57a4-0517b0e639c4", + "resource": { + "resourceType": "Claim", + "id": "7fd0436e-8f09-9730-57a4-0517b0e639c4", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "1984-12-26T08:41:58+01:00", + "end": "1984-12-26T08:56:58+01:00" + }, + "created": "1984-12-26T08:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "NO_INSURANCE" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185345009", + "display": "Encounter for symptom (procedure)" + } ], + "text": "Encounter for symptom (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:0b121219-cbfd-f536-8232-1a33c5e3ea58" + } ] + } ], + "total": { + "value": 516.95, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:c01dd19a-66d1-fb67-d622-dbd4a256068f", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "c01dd19a-66d1-fb67-d622-dbd4a256068f", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "NO_INSURANCE" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "NO_INSURANCE" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "7fd0436e-8f09-9730-57a4-0517b0e639c4" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "1984-12-26T08:56:58+01:00", + "end": "1985-12-26T08:56:58+01:00" + }, + "created": "1984-12-26T08:56:58+01:00", + "insurer": { + "display": "NO_INSURANCE" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:7fd0436e-8f09-9730-57a4-0517b0e639c4" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "NO_INSURANCE" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for symptom (procedure)" + }, + "servicedPeriod": { + "start": "1984-12-26T08:41:58+01:00", + "end": "1984-12-26T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:0b121219-cbfd-f536-8232-1a33c5e3ea58" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 516.95, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:2ec96e33-a527-4e10-6e92-082f99f653e9", + "resource": { + "resourceType": "Encounter", + "id": "2ec96e33-a527-4e10-6e92-082f99f653e9", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "2ec96e33-a527-4e10-6e92-082f99f653e9" + } ], + "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 (procedure)" + } ], + "text": "Encounter for symptom (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "1992-07-25T09:41:58+01:00", + "end": "1992-07-25T09:56:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "1992-07-25T09:41:58+01:00", + "end": "1992-07-25T09:56:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "444814009", + "display": "Viral sinusitis (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:bb88e2de-aaa8-81fa-65bc-aaac5d9085cb", + "resource": { + "resourceType": "MedicationRequest", + "id": "bb88e2de-aaa8-81fa-65bc-aaac5d9085cb", + "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": "1649987", + "display": "doxycycline hyclate 100 MG" + } ], + "text": "doxycycline hyclate 100 MG" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2ec96e33-a527-4e10-6e92-082f99f653e9" + }, + "authoredOn": "1992-07-25T09:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "444814009", + "display": "Viral sinusitis (disorder)" + } ], + "text": "Viral sinusitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:4407160c-bc96-4f59-266a-1b9b741f7b0f", + "resource": { + "resourceType": "Claim", + "id": "4407160c-bc96-4f59-266a-1b9b741f7b0f", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "1992-07-25T09:41:58+01:00", + "end": "1992-07-25T09:56:58+01:00" + }, + "created": "1992-07-25T09:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:bb88e2de-aaa8-81fa-65bc-aaac5d9085cb" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "NO_INSURANCE" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "1649987", + "display": "doxycycline hyclate 100 MG" + } ], + "text": "doxycycline hyclate 100 MG" + }, + "encounter": [ { + "reference": "urn:uuid:2ec96e33-a527-4e10-6e92-082f99f653e9" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:61b12e74-fdf1-a64f-0569-6f96dd4553f3", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "61b12e74-fdf1-a64f-0569-6f96dd4553f3", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "NO_INSURANCE" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "NO_INSURANCE" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "4407160c-bc96-4f59-266a-1b9b741f7b0f" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "1992-07-25T09:56:58+01:00", + "end": "1993-07-25T09:56:58+01:00" + }, + "created": "1992-07-25T09:56:58+01:00", + "insurer": { + "display": "NO_INSURANCE" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:4407160c-bc96-4f59-266a-1b9b741f7b0f" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "NO_INSURANCE" + } + } ], + "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": "1649987", + "display": "doxycycline hyclate 100 MG" + } ], + "text": "doxycycline hyclate 100 MG" + }, + "servicedPeriod": { + "start": "1992-07-25T09:41:58+01:00", + "end": "1992-07-25T09:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:2ec96e33-a527-4e10-6e92-082f99f653e9" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:5cf021a1-6e2f-9fcf-00a8-6177ba185401", + "resource": { + "resourceType": "DiagnosticReport", + "id": "5cf021a1-6e2f-9fcf-00a8-6177ba185401", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2ec96e33-a527-4e10-6e92-082f99f653e9" + }, + "effectiveDateTime": "1992-07-25T09:41:58+01:00", + "issued": "1992-07-25T09:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:b2e52643-5d80-291f-f886-b3611f7edb7e", + "resource": { + "resourceType": "DocumentReference", + "id": "b2e52643-5d80-291f-f886-b3611f7edb7e", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:5cf021a1-6e2f-9fcf-00a8-6177ba185401" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "1992-07-25T09:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:2ec96e33-a527-4e10-6e92-082f99f653e9" + } ], + "period": { + "start": "1992-07-25T09:41:58+01:00", + "end": "1992-07-25T09:56:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:e7ababff-5e9a-b815-8392-f1b5c0d77300", + "resource": { + "resourceType": "Claim", + "id": "e7ababff-5e9a-b815-8392-f1b5c0d77300", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "1992-07-25T09:41:58+01:00", + "end": "1992-07-25T09:56:58+01:00" + }, + "created": "1992-07-25T09:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "NO_INSURANCE" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185345009", + "display": "Encounter for symptom (procedure)" + } ], + "text": "Encounter for symptom (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:2ec96e33-a527-4e10-6e92-082f99f653e9" + } ] + } ], + "total": { + "value": 85.55, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:cfe48f43-a003-9b3b-79bb-61157c242c2b", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "cfe48f43-a003-9b3b-79bb-61157c242c2b", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "NO_INSURANCE" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "NO_INSURANCE" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "e7ababff-5e9a-b815-8392-f1b5c0d77300" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "1992-07-25T09:56:58+01:00", + "end": "1993-07-25T09:56:58+01:00" + }, + "created": "1992-07-25T09:56:58+01:00", + "insurer": { + "display": "NO_INSURANCE" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:e7ababff-5e9a-b815-8392-f1b5c0d77300" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "NO_INSURANCE" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for symptom (procedure)" + }, + "servicedPeriod": { + "start": "1992-07-25T09:41:58+01:00", + "end": "1992-07-25T09:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:2ec96e33-a527-4e10-6e92-082f99f653e9" + } ] + } ], + "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:7b34cd19-6045-aae8-1f0d-1f34a6bb5dff", + "resource": { + "resourceType": "Encounter", + "id": "7b34cd19-6045-aae8-1f0d-1f34a6bb5dff", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "7b34cd19-6045-aae8-1f0d-1f34a6bb5dff" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "1998-04-19T08:41:58+01:00", + "end": "1998-04-19T09:19:14+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "1998-04-19T08:41:58+01:00", + "end": "1998-04-19T09:19:14+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:9d9a5619-1f27-75c0-0508-97197f054620", + "resource": { + "resourceType": "Condition", + "id": "9d9a5619-1f27-75c0-0508-97197f054620", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:7b34cd19-6045-aae8-1f0d-1f34a6bb5dff" + }, + "onsetDateTime": "1998-04-19T09:19:14+01:00", + "recordedDate": "1998-04-19T09:19:14+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:a294bac2-021d-d293-4f2c-8c2a65654313", + "resource": { + "resourceType": "DiagnosticReport", + "id": "a294bac2-021d-d293-4f2c-8c2a65654313", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:7b34cd19-6045-aae8-1f0d-1f34a6bb5dff" + }, + "effectiveDateTime": "1998-04-19T08:41:58+01:00", + "issued": "1998-04-19T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:d7480f50-0241-dd79-12cc-0cb4c0cd2094", + "resource": { + "resourceType": "DocumentReference", + "id": "d7480f50-0241-dd79-12cc-0cb4c0cd2094", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:a294bac2-021d-d293-4f2c-8c2a65654313" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "1998-04-19T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:7b34cd19-6045-aae8-1f0d-1f34a6bb5dff" + } ], + "period": { + "start": "1998-04-19T08:41:58+01:00", + "end": "1998-04-19T09:19:14+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:7a4b8673-b4bb-3cbb-f01b-38d92cdcd609", + "resource": { + "resourceType": "Claim", + "id": "7a4b8673-b4bb-3cbb-f01b-38d92cdcd609", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "1998-04-19T08:41:58+01:00", + "end": "1998-04-19T09:19:14+01:00" + }, + "created": "1998-04-19T09:19:14+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:9d9a5619-1f27-75c0-0508-97197f054620" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "NO_INSURANCE" + } + } ], + "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:7b34cd19-6045-aae8-1f0d-1f34a6bb5dff" + } ] + }, { + "sequence": 2, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "224299000", + "display": "Received higher education (finding)" + } ], + "text": "Received higher education (finding)" + } + } ], + "total": { + "value": 704.20, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:aa5500d4-7691-bb63-215d-2f98446dcfd8", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "aa5500d4-7691-bb63-215d-2f98446dcfd8", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "NO_INSURANCE" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "NO_INSURANCE" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "7a4b8673-b4bb-3cbb-f01b-38d92cdcd609" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "1998-04-19T09:19:14+01:00", + "end": "1999-04-19T09:19:14+01:00" + }, + "created": "1998-04-19T09:19:14+01:00", + "insurer": { + "display": "NO_INSURANCE" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:7a4b8673-b4bb-3cbb-f01b-38d92cdcd609" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:9d9a5619-1f27-75c0-0508-97197f054620" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "NO_INSURANCE" + } + } ], + "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": "1998-04-19T08:41:58+01:00", + "end": "1998-04-19T09:19:14+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:7b34cd19-6045-aae8-1f0d-1f34a6bb5dff" + } ] + }, { + "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": "224299000", + "display": "Received higher education (finding)" + } ], + "text": "Received higher education (finding)" + }, + "servicedPeriod": { + "start": "1998-04-19T08:41:58+01:00", + "end": "1998-04-19T09:19:14+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 704.20, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:a5dd61b7-7615-95bf-88b8-da5f4174c495", + "resource": { + "resourceType": "Encounter", + "id": "a5dd61b7-7615-95bf-88b8-da5f4174c495", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "a5dd61b7-7615-95bf-88b8-da5f4174c495" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2000-04-30T08:41:58+01:00", + "end": "2000-04-30T09:22:28+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2000-04-30T08:41:58+01:00", + "end": "2000-04-30T09:22:28+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:ce15a65b-9636-32ad-d0ed-d58f8ba61ba3", + "resource": { + "resourceType": "Condition", + "id": "ce15a65b-9636-32ad-d0ed-d58f8ba61ba3", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] + }, + "clinicalStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", + "code": "active" + } ] + }, + "verificationStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", + "code": "confirmed" + } ] + }, + "category": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/condition-category", + "code": "encounter-diagnosis", + "display": "Encounter Diagnosis" + } ] + } ], + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "162864005", + "display": "Body mass index 30+ - obesity (finding)" + } ], + "text": "Body mass index 30+ - obesity (finding)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:a5dd61b7-7615-95bf-88b8-da5f4174c495" + }, + "onsetDateTime": "2000-04-30T08:41:58+01:00", + "recordedDate": "2000-04-30T08:41:58+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:26cc320d-0b70-e9f6-b3e9-f40bbdd02f97", + "resource": { + "resourceType": "DiagnosticReport", + "id": "26cc320d-0b70-e9f6-b3e9-f40bbdd02f97", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:a5dd61b7-7615-95bf-88b8-da5f4174c495" + }, + "effectiveDateTime": "2000-04-30T08:41:58+01:00", + "issued": "2000-04-30T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:f8fee68b-0724-0148-f32b-f373f533f6db", + "resource": { + "resourceType": "DocumentReference", + "id": "f8fee68b-0724-0148-f32b-f373f533f6db", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:26cc320d-0b70-e9f6-b3e9-f40bbdd02f97" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2000-04-30T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "content": [ { + "attachment": { + "contentType": "text/plain; charset=utf-8", + "data": "DQoyMDAwLTA0LTMwDQoNCiMgQ2hpZWYgQ29tcGxhaW50DQotIENoZXN0IFByZXNzdXJlDQoNCg0KIyBIaXN0b3J5IG9mIFByZXNlbnQgSWxsbmVzcw0KSGVyYmVydDgzMA0KIGlzIGEgMjAgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4NCg0KIyBTb2NpYWwgSGlzdG9yeQ0KUGF0aWVudCBpcyBtYXJyaWVkLiBQYXRpZW50IHF1aXQgc21va2luZyBhdCBhZ2UgMTYuDQogUGF0aWVudCBpZGVudGlmaWVzIGFzIGhldGVyb3NleHVhbC4NCg0KUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4NCiBQYXRpZW50IGhhcyBjb21wbGV0ZWQgc29tZSBjb2xsZWdlIGNvdXJzZXMuDQpQYXRpZW50IGN1cnJlbnRseSBoYXMgTk8gSU5TVVJBTkNFLg0KDQojIEFsbGVyZ2llcw0KTm8gS25vd24gQWxsZXJnaWVzLg0KDQojIE1lZGljYXRpb25zDQpObyBBY3RpdmUgTWVkaWNhdGlvbnMuDQoNCiMgQXNzZXNzbWVudCBhbmQgUGxhbg0KUGF0aWVudCBpcyBwcmVzZW50aW5nIHdpdGggYm9keSBtYXNzIGluZGV4IDMwKyAtIG9iZXNpdHkgKGZpbmRpbmcpLiANCg0KDQojIyBQbGFuDQoNCg==" + }, + "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:a5dd61b7-7615-95bf-88b8-da5f4174c495" + } ], + "period": { + "start": "2000-04-30T08:41:58+01:00", + "end": "2000-04-30T09:22:28+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:e8e6a336-6adb-c63e-60ea-edc61f89cbe9", + "resource": { + "resourceType": "Claim", + "id": "e8e6a336-6adb-c63e-60ea-edc61f89cbe9", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2000-04-30T08:41:58+01:00", + "end": "2000-04-30T09:22:28+01:00" + }, + "created": "2000-04-30T09:22:28+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:ce15a65b-9636-32ad-d0ed-d58f8ba61ba3" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "NO_INSURANCE" + } + } ], + "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:a5dd61b7-7615-95bf-88b8-da5f4174c495" + } ] + }, { + "sequence": 2, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "162864005", + "display": "Body mass index 30+ - obesity (finding)" + } ], + "text": "Body mass index 30+ - obesity (finding)" + } + } ], + "total": { + "value": 1321.35, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:53f81133-82f6-ab24-cb00-43b29c7cbf98", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "53f81133-82f6-ab24-cb00-43b29c7cbf98", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "NO_INSURANCE" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "NO_INSURANCE" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "e8e6a336-6adb-c63e-60ea-edc61f89cbe9" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2000-04-30T09:22:28+01:00", + "end": "2001-04-30T09:22:28+01:00" + }, + "created": "2000-04-30T09:22:28+01:00", + "insurer": { + "display": "NO_INSURANCE" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:e8e6a336-6adb-c63e-60ea-edc61f89cbe9" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:ce15a65b-9636-32ad-d0ed-d58f8ba61ba3" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "NO_INSURANCE" + } + } ], + "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": "2000-04-30T08:41:58+01:00", + "end": "2000-04-30T09:22:28+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:a5dd61b7-7615-95bf-88b8-da5f4174c495" + } ] + }, { + "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": "162864005", + "display": "Body mass index 30+ - obesity (finding)" + } ], + "text": "Body mass index 30+ - obesity (finding)" + }, + "servicedPeriod": { + "start": "2000-04-30T08:41:58+01:00", + "end": "2000-04-30T09:22:28+01:00" + }, + "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": 1321.35, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:9fa60ac9-aabd-9d66-fe36-2b2d090ef64f", + "resource": { + "resourceType": "Encounter", + "id": "9fa60ac9-aabd-9d66-fe36-2b2d090ef64f", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "9fa60ac9-aabd-9d66-fe36-2b2d090ef64f" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2008-06-15T09:41:58+02:00", + "end": "2008-06-15T10:31:20+02:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2008-06-15T09:41:58+02:00", + "end": "2008-06-15T10:31:20+02:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:b0564bec-da35-247c-2f48-9487964d7595", + "resource": { + "resourceType": "Condition", + "id": "b0564bec-da35-247c-2f48-9487964d7595", + "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": "10939881000119105", + "display": "Unhealthy alcohol drinking behavior (finding)" + } ], + "text": "Unhealthy alcohol drinking behavior (finding)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:9fa60ac9-aabd-9d66-fe36-2b2d090ef64f" + }, + "onsetDateTime": "2008-06-15T11:57:51+02:00", + "abatementDateTime": "2015-07-26T10:43:49+01:00", + "recordedDate": "2008-06-15T11:57:51+02:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:69f56969-128d-c798-807b-9de01a889115", + "resource": { + "resourceType": "DiagnosticReport", + "id": "69f56969-128d-c798-807b-9de01a889115", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:9fa60ac9-aabd-9d66-fe36-2b2d090ef64f" + }, + "effectiveDateTime": "2008-06-15T09:41:58+02:00", + "issued": "2008-06-15T09:41:58.201+02:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:19f28a0c-8190-54fa-f03e-72c0b3340d39", + "resource": { + "resourceType": "DocumentReference", + "id": "19f28a0c-8190-54fa-f03e-72c0b3340d39", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:69f56969-128d-c798-807b-9de01a889115" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2008-06-15T09:41:58.201+02:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:9fa60ac9-aabd-9d66-fe36-2b2d090ef64f" + } ], + "period": { + "start": "2008-06-15T09:41:58+02:00", + "end": "2008-06-15T10:31:20+02:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:76fbe70b-92c3-e6ad-96bb-ab281e7a92ab", + "resource": { + "resourceType": "Claim", + "id": "76fbe70b-92c3-e6ad-96bb-ab281e7a92ab", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2008-06-15T09:41:58+02:00", + "end": "2008-06-15T10:31:20+02:00" + }, + "created": "2008-06-15T10:31:20+02:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:b0564bec-da35-247c-2f48-9487964d7595" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:9fa60ac9-aabd-9d66-fe36-2b2d090ef64f" + } ] + }, { + "sequence": 2, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "10939881000119105", + "display": "Unhealthy alcohol drinking behavior (finding)" + } ], + "text": "Unhealthy alcohol drinking behavior (finding)" + } + } ], + "total": { + "value": 704.20, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:9ceb7812-bf49-5a16-a29c-98cb111b3637", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "9ceb7812-bf49-5a16-a29c-98cb111b3637", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "76fbe70b-92c3-e6ad-96bb-ab281e7a92ab" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2008-06-15T10:31:20+02:00", + "end": "2009-06-15T10:31:20+01:00" + }, + "created": "2008-06-15T10:31:20+02:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:76fbe70b-92c3-e6ad-96bb-ab281e7a92ab" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:b0564bec-da35-247c-2f48-9487964d7595" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "2008-06-15T09:41:58+02:00", + "end": "2008-06-15T10:31:20+02:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:9fa60ac9-aabd-9d66-fe36-2b2d090ef64f" + } ] + }, { + "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": "10939881000119105", + "display": "Unhealthy alcohol drinking behavior (finding)" + } ], + "text": "Unhealthy alcohol drinking behavior (finding)" + }, + "servicedPeriod": { + "start": "2008-06-15T09:41:58+02:00", + "end": "2008-06-15T10:31:20+02:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 704.20, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:66fb03e2-9520-3de8-62ff-f595a99025d6", + "resource": { + "resourceType": "Encounter", + "id": "66fb03e2-9520-3de8-62ff-f595a99025d6", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "66fb03e2-9520-3de8-62ff-f595a99025d6" + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2013-01-13T08:41:58+01:00", + "end": "2013-01-13T09:28:04+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2013-01-13T08:41:58+01:00", + "end": "2013-01-13T09:28:04+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:8ebeda02-892d-0b31-228c-9e88732e84be", + "resource": { + "resourceType": "Condition", + "id": "8ebeda02-892d-0b31-228c-9e88732e84be", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:66fb03e2-9520-3de8-62ff-f595a99025d6" + }, + "onsetDateTime": "2013-01-13T09:28:04+01:00", + "abatementDateTime": "2015-07-26T09:37:24+01:00", + "recordedDate": "2013-01-13T09:28:04+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:c8f6bae3-b6ed-3d99-047a-b848757880b4", + "resource": { + "resourceType": "DiagnosticReport", + "id": "c8f6bae3-b6ed-3d99-047a-b848757880b4", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:66fb03e2-9520-3de8-62ff-f595a99025d6" + }, + "effectiveDateTime": "2013-01-13T08:41:58+01:00", + "issued": "2013-01-13T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:c8573c68-d18c-f89a-2270-0e44f1781e8f", + "resource": { + "resourceType": "DocumentReference", + "id": "c8573c68-d18c-f89a-2270-0e44f1781e8f", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:c8f6bae3-b6ed-3d99-047a-b848757880b4" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2013-01-13T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:66fb03e2-9520-3de8-62ff-f595a99025d6" + } ], + "period": { + "start": "2013-01-13T08:41:58+01:00", + "end": "2013-01-13T09:28:04+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:64bebb44-eb9e-376e-f91f-b3afa1a8da24", + "resource": { + "resourceType": "Claim", + "id": "64bebb44-eb9e-376e-f91f-b3afa1a8da24", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2013-01-13T08:41:58+01:00", + "end": "2013-01-13T09:28:04+01:00" + }, + "created": "2013-01-13T09:28:04+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:8ebeda02-892d-0b31-228c-9e88732e84be" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185349003", + "display": "Encounter for check up (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:66fb03e2-9520-3de8-62ff-f595a99025d6" + } ] + }, { + "sequence": 2, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "73595000", + "display": "Stress (finding)" + } ], + "text": "Stress (finding)" + } + } ], + "total": { + "value": 652.95, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:6fbe882d-713e-f36f-ef61-1ebc52482e35", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "6fbe882d-713e-f36f-ef61-1ebc52482e35", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "64bebb44-eb9e-376e-f91f-b3afa1a8da24" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2013-01-13T09:28:04+01:00", + "end": "2014-01-13T09:28:04+01:00" + }, + "created": "2013-01-13T09:28:04+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:64bebb44-eb9e-376e-f91f-b3afa1a8da24" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:8ebeda02-892d-0b31-228c-9e88732e84be" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "servicedPeriod": { + "start": "2013-01-13T08:41:58+01:00", + "end": "2013-01-13T09:28:04+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:66fb03e2-9520-3de8-62ff-f595a99025d6" + } ] + }, { + "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": "73595000", + "display": "Stress (finding)" + } ], + "text": "Stress (finding)" + }, + "servicedPeriod": { + "start": "2013-01-13T08:41:58+01:00", + "end": "2013-01-13T09:28:04+01:00" + }, + "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": 652.95, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:5fa53a15-9594-d0f5-fd81-3fd9070015f0", + "resource": { + "resourceType": "Encounter", + "id": "5fa53a15-9594-d0f5-fd81-3fd9070015f0", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "5fa53a15-9594-d0f5-fd81-3fd9070015f0" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2014-07-20T08:41:58+01:00", + "end": "2014-07-20T09:24:00+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2014-07-20T08:41:58+01:00", + "end": "2014-07-20T09:24:00+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:5e4b7fc0-877c-cc03-3ab7-3ffc1d4b7bd2", + "resource": { + "resourceType": "Condition", + "id": "5e4b7fc0-877c-cc03-3ab7-3ffc1d4b7bd2", + "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": "73438004", + "display": "Unemployed (finding)" + } ], + "text": "Unemployed (finding)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + }, + "onsetDateTime": "2014-07-20T09:24:00+01:00", + "abatementDateTime": "2017-08-06T09:31:57+01:00", + "recordedDate": "2014-07-20T09:24:00+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:a56cedd4-6ef8-3872-fe4d-17607a2acc8a", + "resource": { + "resourceType": "MedicationRequest", + "id": "a56cedd4-6ef8-3872-fe4d-17607a2acc8a", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + }, + "authoredOn": "2014-07-20T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:aba8e0b9-67d0-150c-f74f-74b82dd3ea68", + "resource": { + "resourceType": "Claim", + "id": "aba8e0b9-67d0-150c-f74f-74b82dd3ea68", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2014-07-20T08:41:58+01:00", + "end": "2014-07-20T09:24:00+01:00" + }, + "created": "2014-07-20T09:24:00+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:a56cedd4-6ef8-3872-fe4d-17607a2acc8a" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "encounter": [ { + "reference": "urn:uuid:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:740319c3-13ea-9fe2-b059-71ec7cd8b07b", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "740319c3-13ea-9fe2-b059-71ec7cd8b07b", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "aba8e0b9-67d0-150c-f74f-74b82dd3ea68" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2014-07-20T09:24:00+01:00", + "end": "2015-07-20T09:24:00+01:00" + }, + "created": "2014-07-20T09:24:00+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:aba8e0b9-67d0-150c-f74f-74b82dd3ea68" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "servicedPeriod": { + "start": "2014-07-20T08:41:58+01:00", + "end": "2014-07-20T09:24:00+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:4d2b0e1b-5cfb-e667-a4d9-edb0fe00d991", + "resource": { + "resourceType": "MedicationRequest", + "id": "4d2b0e1b-5cfb-e667-a4d9-edb0fe00d991", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + }, + "authoredOn": "2014-07-20T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:9c34d79e-d752-0955-1c69-70de3eb34f64", + "resource": { + "resourceType": "Claim", + "id": "9c34d79e-d752-0955-1c69-70de3eb34f64", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2014-07-20T08:41:58+01:00", + "end": "2014-07-20T09:24:00+01:00" + }, + "created": "2014-07-20T09:24:00+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:4d2b0e1b-5cfb-e667-a4d9-edb0fe00d991" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "encounter": [ { + "reference": "urn:uuid:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:9dafe68a-e0ea-6663-f408-0ff3cefaff9f", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "9dafe68a-e0ea-6663-f408-0ff3cefaff9f", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "9c34d79e-d752-0955-1c69-70de3eb34f64" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2014-07-20T09:24:00+01:00", + "end": "2015-07-20T09:24:00+01:00" + }, + "created": "2014-07-20T09:24:00+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:9c34d79e-d752-0955-1c69-70de3eb34f64" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "servicedPeriod": { + "start": "2014-07-20T08:41:58+01:00", + "end": "2014-07-20T09:24:00+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:999b76b8-7d42-7d6c-fe5a-01fb977e0169", + "resource": { + "resourceType": "DiagnosticReport", + "id": "999b76b8-7d42-7d6c-fe5a-01fb977e0169", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + }, + "effectiveDateTime": "2014-07-20T08:41:58+01:00", + "issued": "2014-07-20T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:9aadc8a7-bf14-2e40-76cd-b3cdb36e4712", + "resource": { + "resourceType": "DocumentReference", + "id": "9aadc8a7-bf14-2e40-76cd-b3cdb36e4712", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:999b76b8-7d42-7d6c-fe5a-01fb977e0169" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2014-07-20T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + } ], + "period": { + "start": "2014-07-20T08:41:58+01:00", + "end": "2014-07-20T09:24:00+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:05d12024-c0a1-f927-6c9f-602804588308", + "resource": { + "resourceType": "Claim", + "id": "05d12024-c0a1-f927-6c9f-602804588308", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2014-07-20T08:41:58+01:00", + "end": "2014-07-20T09:24:00+01:00" + }, + "created": "2014-07-20T09:24:00+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:5e4b7fc0-877c-cc03-3ab7-3ffc1d4b7bd2" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + } ] + }, { + "sequence": 2, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "73438004", + "display": "Unemployed (finding)" + } ], + "text": "Unemployed (finding)" + } + } ], + "total": { + "value": 919.90, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:aae0d9e8-2a65-e17d-6323-3ed983c68521", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "aae0d9e8-2a65-e17d-6323-3ed983c68521", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "05d12024-c0a1-f927-6c9f-602804588308" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2014-07-20T09:24:00+01:00", + "end": "2015-07-20T09:24:00+01:00" + }, + "created": "2014-07-20T09:24:00+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:05d12024-c0a1-f927-6c9f-602804588308" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:5e4b7fc0-877c-cc03-3ab7-3ffc1d4b7bd2" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "2014-07-20T08:41:58+01:00", + "end": "2014-07-20T09:24:00+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + } ] + }, { + "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": "73438004", + "display": "Unemployed (finding)" + } ], + "text": "Unemployed (finding)" + }, + "servicedPeriod": { + "start": "2014-07-20T08:41:58+01:00", + "end": "2014-07-20T09:24:00+01:00" + }, + "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": 919.90, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748", + "resource": { + "resourceType": "Encounter", + "id": "f35b493b-59d0-3544-b183-67869056e748", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "f35b493b-59d0-3544-b183-67869056e748" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:109b07cb-c8f5-c172-b413-6fd2729a8211", + "resource": { + "resourceType": "Condition", + "id": "109b07cb-c8f5-c172-b413-6fd2729a8211", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "onsetDateTime": "2015-07-26T08:41:58+01:00", + "abatementDateTime": "2019-08-18T08:41:58+01:00", + "recordedDate": "2015-07-26T08:41:58+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "resource": { + "resourceType": "Condition", + "id": "bf38b04b-70db-f887-acbb-187fdb365cf4", + "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": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "onsetDateTime": "2015-07-26T10:43:49+01:00", + "abatementDateTime": "2015-08-16T14:35:12+01:00", + "recordedDate": "2015-07-26T10:43:49+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:5f01c036-7761-9d58-e5b7-1370a63d540d", + "resource": { + "resourceType": "Observation", + "id": "5f01c036-7761-9d58-e5b7-1370a63d540d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T08:41:58+01:00", + "issued": "2015-07-26T08:41:58.201+01:00", + "valueQuantity": { + "value": 168.8, + "unit": "cm", + "system": "http://unitsofmeasure.org", + "code": "cm" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:eb66d771-0209-0027-06c4-a34e65aee9b7", + "resource": { + "resourceType": "Observation", + "id": "eb66d771-0209-0027-06c4-a34e65aee9b7", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T08:41:58+01:00", + "issued": "2015-07-26T08:41:58.201+01:00", + "valueQuantity": { + "value": 3, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:63275508-8e01-febc-c8bf-79494f501b88", + "resource": { + "resourceType": "Observation", + "id": "63275508-8e01-febc-c8bf-79494f501b88", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T08:41:58+01:00", + "issued": "2015-07-26T08:41:58.201+01:00", + "valueQuantity": { + "value": 86.8, + "unit": "kg", + "system": "http://unitsofmeasure.org", + "code": "kg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:0cd46938-c34b-4789-1190-3153f5cfc51b", + "resource": { + "resourceType": "Observation", + "id": "0cd46938-c34b-4789-1190-3153f5cfc51b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T08:41:58+01:00", + "issued": "2015-07-26T08:41:58.201+01:00", + "valueQuantity": { + "value": 30.46, + "unit": "kg/m2", + "system": "http://unitsofmeasure.org", + "code": "kg/m2" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:416ac67f-85d4-996d-c846-43721ec9bae1", + "resource": { + "resourceType": "Observation", + "id": "416ac67f-85d4-996d-c846-43721ec9bae1", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T08:41:58+01:00", + "issued": "2015-07-26T08:41:58.201+01:00", + "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": 111, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c98dbf91-d694-d15b-55ee-9109a4372261", + "resource": { + "resourceType": "Observation", + "id": "c98dbf91-d694-d15b-55ee-9109a4372261", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T08:41:58+01:00", + "issued": "2015-07-26T08:41:58.201+01:00", + "valueQuantity": { + "value": 84, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:19dbb124-019f-5cd3-a49f-e4bd15c8eb25", + "resource": { + "resourceType": "Observation", + "id": "19dbb124-019f-5cd3-a49f-e4bd15c8eb25", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T08:41:58+01:00", + "issued": "2015-07-26T08:41:58.201+01:00", + "valueQuantity": { + "value": 13, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:382edf2c-adb9-08ea-2bfd-40df2dc11b5d", + "resource": { + "resourceType": "Observation", + "id": "382edf2c-adb9-08ea-2bfd-40df2dc11b5d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T08:41:58+01:00", + "issued": "2015-07-26T08:41:58.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "8517006", + "display": "Ex-smoker (finding)" + } ], + "text": "Ex-smoker (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:9be33759-efe6-41f8-5337-1f1450d462d5", + "resource": { + "resourceType": "Observation", + "id": "9be33759-efe6-41f8-5337-1f1450d462d5", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T09:37:24+01:00", + "issued": "2015-07-26T09:37:24.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "76501-6", + "display": "Within the last year, have you been afraid of your partner or ex-partner?" + } ], + "text": "Within the last year, have you been afraid of your partner or ex-partner?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93026-3", + "display": "Do you feel physically and emotionally safe where you currently live?" + } ], + "text": "Do you feel physically and emotionally safe where you currently live?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA33-6", + "display": "Yes" + } ], + "text": "Yes" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93027-1", + "display": "Are you a refugee?" + } ], + "text": "Are you a refugee?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93028-9", + "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + } ], + "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93038-8", + "display": "Stress level" + } ], + "text": "Stress level" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA6568-5", + "display": "Not at all" + } ], + "text": "Not at all" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93029-7", + "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + } ], + "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30131-9", + "display": "3 to 5 times a week" + } ], + "text": "3 to 5 times a week" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93030-5", + "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + } ], + "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93031-3", + "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + } ], + "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30125-1", + "display": "Food" + } ], + "text": "Food" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63586-2", + "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + } ], + "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + }, + "valueQuantity": { + "value": 60262, + "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": "LA17956-6", + "display": "Unemployed" + } ], + "text": "Unemployed" + } + }, { + "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": "627 Ullrich Dam Unit 88" + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93033-9", + "display": "Are you worried about losing your housing?" + } ], + "text": "Are you worried about losing your housing?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "71802-3", + "display": "Housing status" + } ], + "text": "Housing status" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30189-7", + "display": "I have housing" + } ], + "text": "I have housing" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63512-8", + "display": "How many people are living or staying at this address?" + } ], + "text": "How many people are living or staying at this address?" + }, + "valueQuantity": { + "value": 7, + "unit": "{#}", + "system": "http://unitsofmeasure.org", + "code": "{#}" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "54899-0", + "display": "Preferred language" + } ], + "text": "Preferred language" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA43-5", + "display": "English" + } ], + "text": "English" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93034-7", + "display": "Have you been discharged from the armed forces of the United States?" + } ], + "text": "Have you been discharged from the armed forces of the United States?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93035-4", + "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + } ], + "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "32624-9", + "display": "Race" + } ], + "text": "Race" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA4457-3", + "display": "White" + } ], + "text": "White" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "56051-6", + "display": "Do you consider yourself Hispanic/Latino?" + } ], + "text": "Do you consider yourself Hispanic/Latino?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:bb82a232-eb21-918c-dbb6-395dbe05c7d8", + "resource": { + "resourceType": "Observation", + "id": "bb82a232-eb21-918c-dbb6-395dbe05c7d8", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T09:59:41+01:00", + "issued": "2015-07-26T09:59:41.201+01:00", + "valueQuantity": { + "value": 6, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:ea7bab83-dcfd-918a-987e-f038af0e1c67", + "resource": { + "resourceType": "Observation", + "id": "ea7bab83-dcfd-918a-987e-f038af0e1c67", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T10:43:49+01:00", + "issued": "2015-07-26T10:43:49.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:905c3dd0-3cd7-6e17-5c24-c4647bb9e9b2", + "resource": { + "resourceType": "Procedure", + "id": "905c3dd0-3cd7-6e17-5c24-c4647bb9e9b2", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "performedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:7da4b763-9225-abe3-da8a-d10799d6c250", + "resource": { + "resourceType": "Procedure", + "id": "7da4b763-9225-abe3-da8a-d10799d6c250", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "performedPeriod": { + "start": "2015-07-26T09:37:24+01:00", + "end": "2015-07-26T09:59:41+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:807a6751-234d-976c-8a08-62ed2f161fb0", + "resource": { + "resourceType": "Procedure", + "id": "807a6751-234d-976c-8a08-62ed2f161fb0", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "performedPeriod": { + "start": "2015-07-26T09:59:41+01:00", + "end": "2015-07-26T10:14:36+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:f479f826-f893-1abf-d154-cb00406e9feb", + "resource": { + "resourceType": "Procedure", + "id": "f479f826-f893-1abf-d154-cb00406e9feb", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "performedPeriod": { + "start": "2015-07-26T10:14:36+01:00", + "end": "2015-07-26T10:43:49+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:47d5c34b-9964-431a-e0b7-b52c7ffc313a", + "resource": { + "resourceType": "Procedure", + "id": "47d5c34b-9964-431a-e0b7-b52c7ffc313a", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "performedPeriod": { + "start": "2015-07-26T10:43:49+01:00", + "end": "2015-07-26T10:51:59+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:e1130c6b-3a01-2fde-1ecd-e7564f473dff", + "resource": { + "resourceType": "MedicationRequest", + "id": "e1130c6b-3a01-2fde-1ecd-e7564f473dff", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "authoredOn": "2015-07-26T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:7a6a1f42-f967-6be0-5131-642b544cc9bb", + "resource": { + "resourceType": "Claim", + "id": "7a6a1f42-f967-6be0-5131-642b544cc9bb", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "created": "2015-07-26T09:37:24+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:e1130c6b-3a01-2fde-1ecd-e7564f473dff" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "encounter": [ { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:2dcb11e8-829f-9758-2ff4-7ad6933c8efa", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "2dcb11e8-829f-9758-2ff4-7ad6933c8efa", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "7a6a1f42-f967-6be0-5131-642b544cc9bb" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-07-26T09:37:24+01:00", + "end": "2016-07-26T09:37:24+01:00" + }, + "created": "2015-07-26T09:37:24+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:7a6a1f42-f967-6be0-5131-642b544cc9bb" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "servicedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:f3c43f0c-1fe9-489b-49dc-0b63c8929261", + "resource": { + "resourceType": "MedicationRequest", + "id": "f3c43f0c-1fe9-489b-49dc-0b63c8929261", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "authoredOn": "2015-07-26T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:2b64e5e1-a663-1acd-651f-931d68f048a2", + "resource": { + "resourceType": "Claim", + "id": "2b64e5e1-a663-1acd-651f-931d68f048a2", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "created": "2015-07-26T09:37:24+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:f3c43f0c-1fe9-489b-49dc-0b63c8929261" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "encounter": [ { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:3997996a-6e1b-1048-4a34-910c70447936", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "3997996a-6e1b-1048-4a34-910c70447936", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "2b64e5e1-a663-1acd-651f-931d68f048a2" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-07-26T09:37:24+01:00", + "end": "2016-07-26T09:37:24+01:00" + }, + "created": "2015-07-26T09:37:24+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:2b64e5e1-a663-1acd-651f-931d68f048a2" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "servicedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:161a7afd-91e4-fa55-9b7d-e35f10d3e821", + "resource": { + "resourceType": "Immunization", + "id": "161a7afd-91e4-fa55-9b7d-e35f10d3e821", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "occurrenceDateTime": "2015-07-26T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:80f6f62f-6b5c-37bd-f838-8aed8bb9301c", + "resource": { + "resourceType": "DiagnosticReport", + "id": "80f6f62f-6b5c-37bd-f838-8aed8bb9301c", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T09:59:41+01:00", + "issued": "2015-07-26T09:59:41.201+01:00", + "result": [ { + "reference": "urn:uuid:bb82a232-eb21-918c-dbb6-395dbe05c7d8", + "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:fcc70716-6056-3da5-4897-310bcbeb6891", + "resource": { + "resourceType": "DiagnosticReport", + "id": "fcc70716-6056-3da5-4897-310bcbeb6891", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T10:43:49+01:00", + "issued": "2015-07-26T10:43:49.201+01:00", + "result": [ { + "reference": "urn:uuid:ea7bab83-dcfd-918a-987e-f038af0e1c67", + "display": "Total score [AUDIT-C]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:33062a82-938c-7023-c600-578f7c7a8018", + "resource": { + "resourceType": "DiagnosticReport", + "id": "33062a82-938c-7023-c600-578f7c7a8018", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, + "effectiveDateTime": "2015-07-26T08:41:58+01:00", + "issued": "2015-07-26T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:501ded03-becd-c5ff-c09d-999b90362946", + "resource": { + "resourceType": "DocumentReference", + "id": "501ded03-becd-c5ff-c09d-999b90362946", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:33062a82-938c-7023-c600-578f7c7a8018" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2015-07-26T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:f35b493b-59d0-3544-b183-67869056e748" + } ], + "period": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:6833d919-dea6-91bb-29d1-7dd2e8b4479c", + "resource": { + "resourceType": "Claim", + "id": "6833d919-dea6-91bb-29d1-7dd2e8b4479c", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "created": "2015-07-26T09:37:24+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:161a7afd-91e4-fa55-9b7d-e35f10d3e821" + } + }, { + "sequence": 2, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + }, { + "sequence": 3, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:109b07cb-c8f5-c172-b413-6fd2729a8211" + } + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:905c3dd0-3cd7-6e17-5c24-c4647bb9e9b2" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:7da4b763-9225-abe3-da8a-d10799d6c250" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:807a6751-234d-976c-8a08-62ed2f161fb0" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:f479f826-f893-1abf-d154-cb00406e9feb" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:47d5c34b-9964-431a-e0b7-b52c7ffc313a" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:f35b493b-59d0-3544-b183-67869056e748" + } ] + }, { + "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": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 5, + "procedureSequence": [ 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": 6, + "informationSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "69737-5", + "display": "Generalized anxiety disorder 7 item (GAD-7)" + } ], + "text": "Generalized anxiety disorder 7 item (GAD-7)" + }, + "net": { + "value": 74.58, + "currency": "USD" + } + }, { + "sequence": 7, + "procedureSequence": [ 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": 8, + "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": 9, + "informationSequence": [ 3 ], + "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" + } + }, { + "sequence": 10, + "diagnosisSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + } + }, { + "sequence": 11, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 704.20, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:9e9b063e-8f43-fb63-15a3-54ba60450fd8", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "9e9b063e-8f43-fb63-15a3-54ba60450fd8", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "6833d919-dea6-91bb-29d1-7dd2e8b4479c" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-07-26T09:37:24+01:00", + "end": "2016-07-26T09:37:24+01:00" + }, + "created": "2015-07-26T09:37:24+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:6833d919-dea6-91bb-29d1-7dd2e8b4479c" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:109b07cb-c8f5-c172-b413-6fd2729a8211" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + } ] + }, { + "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": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 136.00, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 27.200000000000003, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 108.80000000000001, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 136.00, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 136.00, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 3, + "diagnosisSequence": [ 1 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "314529007", + "display": "Medication review due (situation)" + } ], + "text": "Medication review due (situation)" + }, + "servicedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "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": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "servicedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 5, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "710841007", + "display": "Assessment of anxiety (procedure)" + } ], + "text": "Assessment of anxiety (procedure)" + }, + "servicedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 6, + "informationSequence": [ 2 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "69737-5", + "display": "Generalized anxiety disorder 7 item (GAD-7)" + } ], + "text": "Generalized anxiety disorder 7 item (GAD-7)" + }, + "servicedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "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": "428211000124100", + "display": "Assessment of substance use (procedure)" + } ], + "text": "Assessment of substance use (procedure)" + }, + "servicedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "763302001", + "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" + } ], + "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" + }, + "servicedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "72109-2", + "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" + } ], + "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" + }, + "servicedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 10, + "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": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + }, + "servicedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "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": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "servicedPeriod": { + "start": "2015-07-26T08:41:58+01:00", + "end": "2015-07-26T09:37:24+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 704.20, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 1953.728, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:7a729d90-ea1b-3900-2f45-0951ed82c29d", + "resource": { + "resourceType": "Encounter", + "id": "7a729d90-ea1b-3900-2f45-0951ed82c29d", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "7a729d90-ea1b-3900-2f45-0951ed82c29d" + } ], + "status": "finished", + "class": { + "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", + "code": "AMB" + }, + "type": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2015-07-29T11:41:58+01:00", + "end": "2015-07-29T11:56:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2015-07-29T11:41:58+01:00", + "end": "2015-07-29T11:56:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "195967001", + "display": "Asthma (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:4d136b62-9498-5c0c-e00d-986f7d866c01", + "resource": { + "resourceType": "DiagnosticReport", + "id": "4d136b62-9498-5c0c-e00d-986f7d866c01", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:7a729d90-ea1b-3900-2f45-0951ed82c29d" + }, + "effectiveDateTime": "2015-07-29T11:41:58+01:00", + "issued": "2015-07-29T11:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:557db9d4-28d4-c204-c5fd-666bfa3d254b", + "resource": { + "resourceType": "DocumentReference", + "id": "557db9d4-28d4-c204-c5fd-666bfa3d254b", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:4d136b62-9498-5c0c-e00d-986f7d866c01" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2015-07-29T11:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:7a729d90-ea1b-3900-2f45-0951ed82c29d" + } ], + "period": { + "start": "2015-07-29T11:41:58+01:00", + "end": "2015-07-29T11:56:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:985af010-a6ff-4d67-bd61-35effdc26dd4", + "resource": { + "resourceType": "Claim", + "id": "985af010-a6ff-4d67-bd61-35effdc26dd4", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2015-07-29T11:41:58+01:00", + "end": "2015-07-29T11:56:58+01:00" + }, + "created": "2015-07-29T11:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "encounter": [ { + "reference": "urn:uuid:7a729d90-ea1b-3900-2f45-0951ed82c29d" + } ] + } ], + "total": { + "value": 142.58, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:e97a7cb9-3635-1472-65f4-b6f4ba5c545e", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "e97a7cb9-3635-1472-65f4-b6f4ba5c545e", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "985af010-a6ff-4d67-bd61-35effdc26dd4" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-07-29T11:56:58+01:00", + "end": "2016-07-29T11:56:58+01:00" + }, + "created": "2015-07-29T11:56:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:985af010-a6ff-4d67-bd61-35effdc26dd4" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "servicedPeriod": { + "start": "2015-07-29T11:41:58+01:00", + "end": "2015-07-29T11:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:7a729d90-ea1b-3900-2f45-0951ed82c29d" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 142.58, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00", + "resource": { + "resourceType": "Encounter", + "id": "24eae8db-7b14-53e3-fb1f-7b830e6d8b00", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } + } ], + "period": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "48333001", + "display": "Burn injury (morphologic abnormality)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:31feafd9-3647-055c-0657-29cc82a8e1d8", + "resource": { + "resourceType": "Condition", + "id": "31feafd9-3647-055c-0657-29cc82a8e1d8", + "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": "48333001", + "display": "Burn injury (morphologic abnormality)" + } ], + "text": "Burn injury (morphologic abnormality)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + }, + "onsetDateTime": "2015-08-02T08:41:58+01:00", + "abatementDateTime": "2015-08-22T08:41:58+01:00", + "recordedDate": "2015-08-02T08:41:58+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:7b571ec6-fa1a-095b-166f-5aa7c29f8a82", + "resource": { + "resourceType": "Condition", + "id": "7b571ec6-fa1a-095b-166f-5aa7c29f8a82", + "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": "403191005", + "display": "Partial thickness burn (disorder)" + } ], + "text": "Partial thickness burn (disorder)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + }, + "onsetDateTime": "2015-08-02T08:41:58+01:00", + "abatementDateTime": "2015-08-22T08:41:58+01:00", + "recordedDate": "2015-08-02T08:41:58+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:be71ed5b-5b24-403b-63f3-b1753f1e23c2", + "resource": { + "resourceType": "MedicationRequest", + "id": "be71ed5b-5b24-403b-63f3-b1753f1e23c2", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "200346", + "display": "Cefdinir" + } ], + "text": "Cefdinir" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + }, + "authoredOn": "2015-08-02T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:216313c3-8c01-e9ce-e20a-f0c9761a6414", + "resource": { + "resourceType": "Claim", + "id": "216313c3-8c01-e9ce-e20a-f0c9761a6414", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "created": "2015-08-02T09:41:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:be71ed5b-5b24-403b-63f3-b1753f1e23c2" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "200346", + "display": "Cefdinir" + } ], + "text": "Cefdinir" + }, + "encounter": [ { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:23ce0beb-df65-ed01-7252-e00df3da6409", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "23ce0beb-df65-ed01-7252-e00df3da6409", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "216313c3-8c01-e9ce-e20a-f0c9761a6414" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-08-02T09:41:58+01:00", + "end": "2016-08-02T09:41:58+01:00" + }, + "created": "2015-08-02T09:41:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "claim": { + "reference": "urn:uuid:216313c3-8c01-e9ce-e20a-f0c9761a6414" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "200346", + "display": "Cefdinir" + } ], + "text": "Cefdinir" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:568cb55b-b8b8-5df5-dc2a-bbe9925cc2a1", + "resource": { + "resourceType": "MedicationRequest", + "id": "568cb55b-b8b8-5df5-dc2a-bbe9925cc2a1", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "1049221", + "display": "Acetaminophen 325 MG / oxyCODONE Hydrochloride 5 MG Oral Tablet" + } ], + "text": "Acetaminophen 325 MG / oxyCODONE Hydrochloride 5 MG Oral Tablet" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + }, + "authoredOn": "2015-08-02T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + }, + "dosageInstruction": [ { + "sequence": 1, + "timing": { + "repeat": { + "frequency": 1, + "period": 6.0, + "periodUnit": "h" + } + }, + "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:c8d73ac6-092c-831e-e881-9699f51cf433", + "resource": { + "resourceType": "Claim", + "id": "c8d73ac6-092c-831e-e881-9699f51cf433", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "created": "2015-08-02T09:41:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:568cb55b-b8b8-5df5-dc2a-bbe9925cc2a1" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "1049221", + "display": "Acetaminophen 325 MG / oxyCODONE Hydrochloride 5 MG Oral Tablet" + } ], + "text": "Acetaminophen 325 MG / oxyCODONE Hydrochloride 5 MG Oral Tablet" + }, + "encounter": [ { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + } ] + } ], + "total": { + "value": 7.41, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:8d0d4613-7724-fcba-cf2e-8d5ae7a9e507", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "8d0d4613-7724-fcba-cf2e-8d5ae7a9e507", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "c8d73ac6-092c-831e-e881-9699f51cf433" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-08-02T09:41:58+01:00", + "end": "2016-08-02T09:41:58+01:00" + }, + "created": "2015-08-02T09:41:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "claim": { + "reference": "urn:uuid:c8d73ac6-092c-831e-e881-9699f51cf433" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "1049221", + "display": "Acetaminophen 325 MG / oxyCODONE Hydrochloride 5 MG Oral Tablet" + } ], + "text": "Acetaminophen 325 MG / oxyCODONE Hydrochloride 5 MG Oral Tablet" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 7.41, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:699d7ec0-3ef6-e032-910d-b8a1a6e6cf8f", + "resource": { + "resourceType": "MedicationRequest", + "id": "699d7ec0-3ef6-e032-910d-b8a1a6e6cf8f", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + }, + "authoredOn": "2015-08-02T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + }, + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:299b83a1-f578-72d2-3a66-bb0fc585bf1b", + "resource": { + "resourceType": "Claim", + "id": "299b83a1-f578-72d2-3a66-bb0fc585bf1b", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "created": "2015-08-02T09:41:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:699d7ec0-3ef6-e032-910d-b8a1a6e6cf8f" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + } ] + } ], + "total": { + "value": 91.72, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:c73c667d-4b83-2606-8950-07b254084324", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "c73c667d-4b83-2606-8950-07b254084324", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "299b83a1-f578-72d2-3a66-bb0fc585bf1b" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-08-02T09:41:58+01:00", + "end": "2016-08-02T09:41:58+01:00" + }, + "created": "2015-08-02T09:41:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "claim": { + "reference": "urn:uuid:299b83a1-f578-72d2-3a66-bb0fc585bf1b" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 91.72, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:bf3c5fe7-3f65-c4eb-0dc1-340953da3bf4", + "resource": { + "resourceType": "CareTeam", + "id": "bf3c5fe7-3f65-c4eb-0dc1-340953da3bf4", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] + }, + "status": "inactive", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + }, + "period": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-22T08:41:58+01:00" + }, + "participant": [ { + "role": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "116154003", + "display": "Patient" + } ], + "text": "Patient" + } ], + "member": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + } + }, { + "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|9999886895", + "display": "Dr. Damon455 Schultz619" + } + }, { + "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|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } ], + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "403191005", + "display": "Partial thickness burn (disorder)" + } ], + "text": "Partial thickness burn (disorder)" + } ], + "managingOrganization": [ { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } ] + }, + "request": { + "method": "POST", + "url": "CareTeam" + } + }, { + "fullUrl": "urn:uuid:d9c67c15-2281-fd25-a022-49cbcb395972", + "resource": { + "resourceType": "CarePlan", + "id": "d9c67c15-2281-fd25-a022-49cbcb395972", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] + }, + "text": { + "status": "generated", + "div": "
Care Plan for Burn care (regime/therapy).
Care plan is meant to treat Partial thickness burn (disorder).
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": "133901003", + "display": "Burn care (regime/therapy)" + } ], + "text": "Burn care (regime/therapy)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + }, + "period": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-22T08:41:58+01:00" + }, + "careTeam": [ { + "reference": "urn:uuid:bf3c5fe7-3f65-c4eb-0dc1-340953da3bf4" + } ], + "addresses": [ { + "reference": "urn:uuid:7b571ec6-fa1a-095b-166f-5aa7c29f8a82" + } ], + "activity": [ { + "detail": { + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "385949008", + "display": "Dressing change management (procedure)" + } ], + "text": "Dressing change management (procedure)" + }, + "reasonReference": [ { + "reference": "urn:uuid:7b571ec6-fa1a-095b-166f-5aa7c29f8a82" + } ], + "status": "completed", + "location": { + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } + }, { + "detail": { + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "440381005", + "display": "Behavior to prevent sun exposure (observable entity)" + } ], + "text": "Behavior to prevent sun exposure (observable entity)" + }, + "reasonReference": [ { + "reference": "urn:uuid:7b571ec6-fa1a-095b-166f-5aa7c29f8a82" + } ], + "status": "completed", + "location": { + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } + }, { + "detail": { + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "439830001", + "display": "Behavior to prevent infection (observable entity)" + } ], + "text": "Behavior to prevent infection (observable entity)" + }, + "reasonReference": [ { + "reference": "urn:uuid:7b571ec6-fa1a-095b-166f-5aa7c29f8a82" + } ], + "status": "completed", + "location": { + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } + } ] + }, + "request": { + "method": "POST", + "url": "CarePlan" + } + }, { + "fullUrl": "urn:uuid:27e4881c-73f1-8594-cab5-56ab54f0dec3", + "resource": { + "resourceType": "DiagnosticReport", + "id": "27e4881c-73f1-8594-cab5-56ab54f0dec3", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + }, + "effectiveDateTime": "2015-08-02T08:41:58+01:00", + "issued": "2015-08-02T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:b8a35a16-bf25-b446-b36c-d72d455a2b4e", + "resource": { + "resourceType": "DocumentReference", + "id": "b8a35a16-bf25-b446-b36c-d72d455a2b4e", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:27e4881c-73f1-8594-cab5-56ab54f0dec3" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2015-08-02T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "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:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + } ], + "period": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:95a93ad6-91c5-ee36-2ade-7d569b6f9e44", + "resource": { + "resourceType": "Claim", + "id": "95a93ad6-91c5-ee36-2ade-7d569b6f9e44", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "institutional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "created": "2015-08-02T09:41:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:31feafd9-3647-055c-0657-29cc82a8e1d8" + } + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:7b571ec6-fa1a-095b-166f-5aa7c29f8a82" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + } ] + }, { + "sequence": 2, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "48333001", + "display": "Burn injury (morphologic abnormality)" + } ], + "text": "Burn injury (morphologic abnormality)" + } + }, { + "sequence": 3, + "diagnosisSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "403191005", + "display": "Partial thickness burn (disorder)" + } ], + "text": "Partial thickness burn (disorder)" + } + } ], + "total": { + "value": 146.18, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:4e6a6bac-3694-cb94-ef9f-743153b28da7", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "4e6a6bac-3694-cb94-ef9f-743153b28da7", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "95a93ad6-91c5-ee36-2ade-7d569b6f9e44" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-08-02T09:41:58+01:00", + "end": "2016-08-02T09:41:58+01:00" + }, + "created": "2015-08-02T09:41:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "claim": { + "reference": "urn:uuid:95a93ad6-91c5-ee36-2ade-7d569b6f9e44" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:31feafd9-3647-055c-0657-29cc82a8e1d8" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:7b571ec6-fa1a-095b-166f-5aa7c29f8a82" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + } ] + }, { + "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": "48333001", + "display": "Burn injury (morphologic abnormality)" + } ], + "text": "Burn injury (morphologic abnormality)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "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": "403191005", + "display": "Partial thickness burn (disorder)" + } ], + "text": "Partial thickness burn (disorder)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T09:41:58+01:00" + }, + "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:96e52485-3069-2658-f7ed-458b0ef5fffd", + "resource": { + "resourceType": "Encounter", + "id": "96e52485-3069-2658-f7ed-458b0ef5fffd", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "96e52485-3069-2658-f7ed-458b0ef5fffd" + } ], + "status": "finished", + "class": { + "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", + "code": "IMP" + }, + "type": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "32485007", + "display": "Hospital admission (procedure)" + } ], + "text": "Hospital admission (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999874594", + "display": "Dr. Chantal971 Lehner980" + } + } ], + "period": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "25675004", + "display": "Patient transfer to skilled nursing facility (procedure)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|f5c6acf1-d209-3ba2-9fec-f70dda7001f0", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:b6528239-3e4d-401c-9bb9-9616a083bd27", + "resource": { + "resourceType": "Procedure", + "id": "b6528239-3e4d-401c-9bb9-9616a083bd27", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "63332003", + "display": "History AND physical examination (procedure)" + } ], + "text": "History AND physical examination (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:48b5e9b0-bd78-a207-701e-781669b7c531", + "resource": { + "resourceType": "Procedure", + "id": "48b5e9b0-bd78-a207-701e-781669b7c531", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "315639002", + "display": "Initial patient assessment (procedure)" + } ], + "text": "Initial patient assessment (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:1cf7f9ec-0432-75df-496a-bb0235eeacc0", + "resource": { + "resourceType": "Procedure", + "id": "1cf7f9ec-0432-75df-496a-bb0235eeacc0", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "370789001", + "display": "Development of individualized plan of care (procedure)" + } ], + "text": "Development of individualized plan of care (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:1ada5364-a0b3-da96-c9e2-56e658f83736", + "resource": { + "resourceType": "Procedure", + "id": "1ada5364-a0b3-da96-c9e2-56e658f83736", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-02T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:20179134-7431-ec82-6b55-f74b9490db46", + "resource": { + "resourceType": "Procedure", + "id": "20179134-7431-ec82-6b55-f74b9490db46", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-03T08:41:58+01:00", + "end": "2015-08-03T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:330be0c9-26f1-dc94-5a34-f6c116719e77", + "resource": { + "resourceType": "Procedure", + "id": "330be0c9-26f1-dc94-5a34-f6c116719e77", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "84478008", + "display": "Occupational therapy (regime/therapy)" + } ], + "text": "Occupational therapy (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-03T08:41:58+01:00", + "end": "2015-08-03T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:56f683ed-da22-9ab6-171d-aabfd01af7bb", + "resource": { + "resourceType": "Procedure", + "id": "56f683ed-da22-9ab6-171d-aabfd01af7bb", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-04T08:41:58+01:00", + "end": "2015-08-04T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:ad942d36-4587-8fc2-4430-8eeacbc2efae", + "resource": { + "resourceType": "Procedure", + "id": "ad942d36-4587-8fc2-4430-8eeacbc2efae", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-05T08:41:58+01:00", + "end": "2015-08-05T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:f8cc502d-d0e2-7035-eee8-a94064ab8b0f", + "resource": { + "resourceType": "Procedure", + "id": "f8cc502d-d0e2-7035-eee8-a94064ab8b0f", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "84478008", + "display": "Occupational therapy (regime/therapy)" + } ], + "text": "Occupational therapy (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-05T08:41:58+01:00", + "end": "2015-08-05T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:6ec7335a-cee8-d9d1-fb0a-45824d09e3c0", + "resource": { + "resourceType": "Procedure", + "id": "6ec7335a-cee8-d9d1-fb0a-45824d09e3c0", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-06T08:41:58+01:00", + "end": "2015-08-06T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:aacbc599-9bf7-f65a-30ce-84974b8e8c06", + "resource": { + "resourceType": "Procedure", + "id": "aacbc599-9bf7-f65a-30ce-84974b8e8c06", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-07T08:41:58+01:00", + "end": "2015-08-07T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:9ad81788-b966-9546-3ce7-b5f38fefca77", + "resource": { + "resourceType": "Procedure", + "id": "9ad81788-b966-9546-3ce7-b5f38fefca77", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225386006", + "display": "Pre-discharge assessment (procedure)" + } ], + "text": "Pre-discharge assessment (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-08T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:b5da1e37-8c64-bc70-a119-ac44348a06f5", + "resource": { + "resourceType": "Procedure", + "id": "b5da1e37-8c64-bc70-a119-ac44348a06f5", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "308283009", + "display": "Discharge from hospital (procedure)" + } ], + "text": "Discharge from hospital (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "performedPeriod": { + "start": "2015-08-08T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:325345e3-d060-4c97-0c76-600f4577824e", + "resource": { + "resourceType": "Device", + "id": "325345e3-d060-4c97-0c76-600f4577824e", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ] + }, + "udiCarrier": [ { + "deviceIdentifier": "79094601312457", + "carrierHRF": "(01)79094601312457(11)150712(17)400726(10)741716083515988058(21)380542560134105779" + } ], + "status": "active", + "distinctIdentifier": "79094601312457", + "manufactureDate": "2015-07-12T08:41:58+01:00", + "expirationDate": "2040-07-26T08:41:58+01:00", + "lotNumber": "741716083515988058", + "serialNumber": "380542560134105779", + "deviceName": [ { + "name": "Manual wheelchair (physical object)", + "type": "user-friendly-name" + } ], + "type": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "228869008", + "display": "Manual wheelchair (physical object)" + } ], + "text": "Manual wheelchair (physical object)" + }, + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + } + }, + "request": { + "method": "POST", + "url": "Device" + } + }, { + "fullUrl": "urn:uuid:17492639-78a5-a7c6-5cea-b3573aa45a25", + "resource": { + "resourceType": "DiagnosticReport", + "id": "17492639-78a5-a7c6-5cea-b3573aa45a25", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, + "effectiveDateTime": "2015-08-02T08:41:58+01:00", + "issued": "2015-08-02T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999874594", + "display": "Dr. Chantal971 Lehner980" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:69aba269-7f0b-6c3e-5f3e-9c968bf45a4e", + "resource": { + "resourceType": "DocumentReference", + "id": "69aba269-7f0b-6c3e-5f3e-9c968bf45a4e", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:17492639-78a5-a7c6-5cea-b3573aa45a25" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2015-08-02T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999874594", + "display": "Dr. Chantal971 Lehner980" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|f5c6acf1-d209-3ba2-9fec-f70dda7001f0", + "display": "BEAR MOUNTAIN 320 OPERATING 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:96e52485-3069-2658-f7ed-458b0ef5fffd" + } ], + "period": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:a4a3dad3-80e5-6755-f9b5-66ddf581fae5", + "resource": { + "resourceType": "Claim", + "id": "a4a3dad3-80e5-6755-f9b5-66ddf581fae5", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "institutional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "created": "2015-08-08T08:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|f5c6acf1-d209-3ba2-9fec-f70dda7001f0", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:b6528239-3e4d-401c-9bb9-9616a083bd27" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:48b5e9b0-bd78-a207-701e-781669b7c531" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:1cf7f9ec-0432-75df-496a-bb0235eeacc0" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:1ada5364-a0b3-da96-c9e2-56e658f83736" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:20179134-7431-ec82-6b55-f74b9490db46" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:330be0c9-26f1-dc94-5a34-f6c116719e77" + } + }, { + "sequence": 7, + "procedureReference": { + "reference": "urn:uuid:56f683ed-da22-9ab6-171d-aabfd01af7bb" + } + }, { + "sequence": 8, + "procedureReference": { + "reference": "urn:uuid:ad942d36-4587-8fc2-4430-8eeacbc2efae" + } + }, { + "sequence": 9, + "procedureReference": { + "reference": "urn:uuid:f8cc502d-d0e2-7035-eee8-a94064ab8b0f" + } + }, { + "sequence": 10, + "procedureReference": { + "reference": "urn:uuid:6ec7335a-cee8-d9d1-fb0a-45824d09e3c0" + } + }, { + "sequence": 11, + "procedureReference": { + "reference": "urn:uuid:aacbc599-9bf7-f65a-30ce-84974b8e8c06" + } + }, { + "sequence": 12, + "procedureReference": { + "reference": "urn:uuid:9ad81788-b966-9546-3ce7-b5f38fefca77" + } + }, { + "sequence": 13, + "procedureReference": { + "reference": "urn:uuid:b5da1e37-8c64-bc70-a119-ac44348a06f5" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "32485007", + "display": "Hospital admission (procedure)" + } ], + "text": "Hospital admission (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + } ] + }, { + "sequence": 2, + "procedureSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "63332003", + "display": "History AND physical examination (procedure)" + } ], + "text": "History AND physical examination (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 3, + "procedureSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "315639002", + "display": "Initial patient assessment (procedure)" + } ], + "text": "Initial patient assessment (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 4, + "informationSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "228869008", + "display": "Manual wheelchair (physical object)" + } ], + "text": "Manual wheelchair (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 5, + "procedureSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "370789001", + "display": "Development of individualized plan of care (procedure)" + } ], + "text": "Development of individualized plan of care (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 6, + "procedureSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 7, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 8, + "procedureSequence": [ 6 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "84478008", + "display": "Occupational therapy (regime/therapy)" + } ], + "text": "Occupational therapy (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 9, + "procedureSequence": [ 7 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 10, + "procedureSequence": [ 8 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 11, + "procedureSequence": [ 9 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "84478008", + "display": "Occupational therapy (regime/therapy)" + } ], + "text": "Occupational therapy (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 12, + "procedureSequence": [ 10 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 13, + "procedureSequence": [ 11 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 14, + "procedureSequence": [ 12 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225386006", + "display": "Pre-discharge assessment (procedure)" + } ], + "text": "Pre-discharge assessment (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 15, + "procedureSequence": [ 13 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "308283009", + "display": "Discharge from hospital (procedure)" + } ], + "text": "Discharge from hospital (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 5719.12, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:36542457-9cfa-ea27-d0d8-66e62bdbf3f7", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "36542457-9cfa-ea27-d0d8-66e62bdbf3f7", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999874594" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999874594" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "a4a3dad3-80e5-6755-f9b5-66ddf581fae5" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-08-08T08:56:58+01:00", + "end": "2016-08-08T08:56:58+01:00" + }, + "created": "2015-08-08T08:56:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999874594" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|587fe6f3-b5e2-335f-89ec-716b2e55a4ad", + "display": "BEAR MOUNTAIN 320 OPERATING LLC" + }, + "claim": { + "reference": "urn:uuid:a4a3dad3-80e5-6755-f9b5-66ddf581fae5" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999874594" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "32485007", + "display": "Hospital admission (procedure)" + } ], + "text": "Hospital admission (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + } ] + }, { + "sequence": 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": "63332003", + "display": "History AND physical examination (procedure)" + } ], + "text": "History AND physical examination (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "315639002", + "display": "Initial patient assessment (procedure)" + } ], + "text": "Initial patient assessment (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "228869008", + "display": "Manual wheelchair (physical object)" + } ], + "text": "Manual wheelchair (physical object)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "370789001", + "display": "Development of individualized plan of care (procedure)" + } ], + "text": "Development of individualized plan of care (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 6, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "84478008", + "display": "Occupational therapy (regime/therapy)" + } ], + "text": "Occupational therapy (regime/therapy)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "84478008", + "display": "Occupational therapy (regime/therapy)" + } ], + "text": "Occupational therapy (regime/therapy)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "410401003", + "display": "Nursing care/supplementary surveillance (regime/therapy)" + } ], + "text": "Nursing care/supplementary surveillance (regime/therapy)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "225386006", + "display": "Pre-discharge assessment (procedure)" + } ], + "text": "Pre-discharge assessment (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "308283009", + "display": "Discharge from hospital (procedure)" + } ], + "text": "Discharge from hospital (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-02T08:41:58+01:00", + "end": "2015-08-08T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 5719.12, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 4486.5599999999995, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95", + "resource": { + "resourceType": "Encounter", + "id": "5cf21de5-b7f3-0090-6719-d1ec48728e95", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "5cf21de5-b7f3-0090-6719-d1ec48728e95" + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "66383009", + "display": "Gingivitis (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:a06dffbd-e266-8a2c-428d-9b57ae44a5c8", + "resource": { + "resourceType": "Condition", + "id": "a06dffbd-e266-8a2c-428d-9b57ae44a5c8", + "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": "18718003", + "display": "Gingival disease (disorder)" + } ], + "text": "Gingival disease (disorder)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "onsetDateTime": "2015-08-16T11:05:03+01:00", + "abatementDateTime": "2015-08-16T13:24:28+01:00", + "recordedDate": "2015-08-16T11:05:03+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:d1753e1b-62b8-c8c0-440c-0312d8fafa66", + "resource": { + "resourceType": "Procedure", + "id": "d1753e1b-62b8-c8c0-440c-0312d8fafa66", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "performedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T09:09:19+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:34521130-ee86-e7e7-e655-47cc3ba74800", + "resource": { + "resourceType": "Procedure", + "id": "34521130-ee86-e7e7-e655-47cc3ba74800", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "performedPeriod": { + "start": "2015-08-16T09:09:19+01:00", + "end": "2015-08-16T09:49:01+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:43603b05-ba17-d526-8b5d-1379dbca2ca1", + "resource": { + "resourceType": "Procedure", + "id": "43603b05-ba17-d526-8b5d-1379dbca2ca1", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "performedPeriod": { + "start": "2015-08-16T09:49:01+01:00", + "end": "2015-08-16T10:14:10+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:7aa5e536-8c0a-9a98-8f6a-232c3e8025af", + "resource": { + "resourceType": "Procedure", + "id": "7aa5e536-8c0a-9a98-8f6a-232c3e8025af", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "performedPeriod": { + "start": "2015-08-16T10:14:10+01:00", + "end": "2015-08-16T10:33:41+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:266f1b6e-9b07-46b9-1f7a-3284e4e57fea", + "resource": { + "resourceType": "Procedure", + "id": "266f1b6e-9b07-46b9-1f7a-3284e4e57fea", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "performedPeriod": { + "start": "2015-08-16T10:33:41+01:00", + "end": "2015-08-16T11:03:41+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:ea3013cb-b562-cf62-7933-aed5ef46ea8f", + "resource": { + "resourceType": "Procedure", + "id": "ea3013cb-b562-cf62-7933-aed5ef46ea8f", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "performedPeriod": { + "start": "2015-08-16T10:33:41+01:00", + "end": "2015-08-16T11:05:03+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:311cc844-3ee7-4e52-c320-d22456ac98d1", + "resource": { + "resourceType": "Procedure", + "id": "311cc844-3ee7-4e52-c320-d22456ac98d1", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "81733005", + "display": "Dental surgical procedure (procedure)" + } ], + "text": "Dental surgical procedure (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "performedPeriod": { + "start": "2015-08-16T11:05:03+01:00", + "end": "2015-08-16T11:18:47+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:a06dffbd-e266-8a2c-428d-9b57ae44a5c8", + "display": "Gingival disease (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:5007a435-6fc0-5537-3936-abf6dc98d0e8", + "resource": { + "resourceType": "Procedure", + "id": "5007a435-6fc0-5537-3936-abf6dc98d0e8", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "3802001", + "display": "Dental application of desensitizing medicament (procedure)" + } ], + "text": "Dental application of desensitizing medicament (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "performedPeriod": { + "start": "2015-08-16T11:18:47+01:00", + "end": "2015-08-16T12:13:10+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:a06dffbd-e266-8a2c-428d-9b57ae44a5c8", + "display": "Gingival disease (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:b23753f8-96fc-56b7-c06f-ae57183b901e", + "resource": { + "resourceType": "Procedure", + "id": "b23753f8-96fc-56b7-c06f-ae57183b901e", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "64544008", + "display": "Gingivectomy or gingivoplasty, per tooth (procedure)" + } ], + "text": "Gingivectomy or gingivoplasty, per tooth (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "performedPeriod": { + "start": "2015-08-16T12:13:10+01:00", + "end": "2015-08-16T13:24:28+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:a06dffbd-e266-8a2c-428d-9b57ae44a5c8", + "display": "Gingival disease (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:969cb98c-207f-273e-f9cb-11f2f4ab0440", + "resource": { + "resourceType": "Procedure", + "id": "969cb98c-207f-273e-f9cb-11f2f4ab0440", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "456191000124101", + "display": "Postoperative care for dental procedure (regime/therapy)" + } ], + "text": "Postoperative care for dental procedure (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "performedPeriod": { + "start": "2015-08-16T13:24:28+01:00", + "end": "2015-08-16T14:35:12+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:d4f063c5-9383-c224-833e-bb62fc11c1a0", + "resource": { + "resourceType": "Procedure", + "id": "d4f063c5-9383-c224-833e-bb62fc11c1a0", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "performedPeriod": { + "start": "2015-08-16T14:35:12+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:bdb986db-5056-8ac8-ea30-eb030669e1c8", + "resource": { + "resourceType": "Device", + "id": "bdb986db-5056-8ac8-ea30-eb030669e1c8", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ] + }, + "udiCarrier": [ { + "deviceIdentifier": "63256148398406", + "carrierHRF": "(01)63256148398406(11)150726(17)400809(10)50236219028(21)5502416443919176269" + } ], + "status": "active", + "distinctIdentifier": "63256148398406", + "manufactureDate": "2015-07-26T10:33:41+01:00", + "expirationDate": "2040-08-09T10:33:41+01:00", + "lotNumber": "50236219028", + "serialNumber": "5502416443919176269", + "deviceName": [ { + "name": "Dental x-ray system (physical object)", + "type": "user-friendly-name" + } ], + "type": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + } + }, + "request": { + "method": "POST", + "url": "Device" + } + }, { + "fullUrl": "urn:uuid:bf4c36d5-510e-4eae-3c40-f71e47fb9f7c", + "resource": { + "resourceType": "Device", + "id": "bf4c36d5-510e-4eae-3c40-f71e47fb9f7c", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ] + }, + "udiCarrier": [ { + "deviceIdentifier": "18229802586455", + "carrierHRF": "(01)18229802586455(11)150726(17)400809(10)607371676815(21)8778165" + } ], + "status": "active", + "distinctIdentifier": "18229802586455", + "manufactureDate": "2015-07-26T11:05:03+01:00", + "expirationDate": "2040-08-09T11:05:03+01:00", + "lotNumber": "607371676815", + "serialNumber": "8778165", + "deviceName": [ { + "name": "Operating room (environment)", + "type": "user-friendly-name" + } ], + "type": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225738002", + "display": "Operating room (environment)" + } ], + "text": "Operating room (environment)" + }, + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + } + }, + "request": { + "method": "POST", + "url": "Device" + } + }, { + "fullUrl": "urn:uuid:3e59a91a-de23-1588-0d6a-6275a76acfd1", + "resource": { + "resourceType": "SupplyDelivery", + "id": "3e59a91a-de23-1588-0d6a-6275a76acfd1", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + } + }, + "occurrenceDateTime": "2015-08-16T09:49:01+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:986d30be-3799-e3ed-396d-8c258100ec0e", + "resource": { + "resourceType": "SupplyDelivery", + "id": "986d30be-3799-e3ed-396d-8c258100ec0e", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + } + }, + "occurrenceDateTime": "2015-08-16T09:49:01+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:cef2fe42-64f6-9a45-8871-6b56743585ee", + "resource": { + "resourceType": "SupplyDelivery", + "id": "cef2fe42-64f6-9a45-8871-6b56743585ee", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + } + }, + "occurrenceDateTime": "2015-08-16T09:49:01+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:33725ecc-1c24-03b2-e41e-4f1080021626", + "resource": { + "resourceType": "ImagingStudy", + "id": "33725ecc-1c24-03b2-e41e-4f1080021626", + "identifier": [ { + "use": "official", + "system": "urn:ietf:rfc:3986", + "value": "urn:oid:1.2.840.99999999.29775386.1439717621201" + } ], + "status": "available", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "started": "2015-08-16T10:33:41+01:00", + "numberOfSeries": 1, + "numberOfInstances": 1, + "procedureCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + } ], + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "series": [ { + "uid": "1.2.840.99999999.1.45531399.1439717621201", + "number": 1, + "modality": { + "system": "http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html", + "code": "DX", + "display": "Digital Radiography" + }, + "numberOfInstances": 1, + "bodySite": { + "system": "http://snomed.info/sct", + "code": "700016008", + "display": "Structure of region of internal part of mouth (body structure)" + }, + "started": "2015-08-16T10:33:41+01:00", + "instance": [ { + "uid": "1.2.840.99999999.1.1.15890081.1439717621201", + "sopClass": { + "system": "urn:ietf:rfc:3986", + "code": "urn:oid:1.2.840.10008.5.1.4.1.1.1.3" + }, + "number": 1, + "title": "Digital Intra-Oral X-Ray Image" + } ] + } ] + }, + "request": { + "method": "POST", + "url": "ImagingStudy" + } + }, { + "fullUrl": "urn:uuid:de4d9b18-48a6-2894-f71f-773833cc1cee", + "resource": { + "resourceType": "DiagnosticReport", + "id": "de4d9b18-48a6-2894-f71f-773833cc1cee", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, + "effectiveDateTime": "2015-08-16T08:41:58+01:00", + "issued": "2015-08-16T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:085f9a4f-a6af-07d4-3802-6b163590072d", + "resource": { + "resourceType": "DocumentReference", + "id": "085f9a4f-a6af-07d4-3802-6b163590072d", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:de4d9b18-48a6-2894-f71f-773833cc1cee" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2015-08-16T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "content": [ { + "attachment": { + "contentType": "text/plain; charset=utf-8", + "data": "DQoyMDE1LTA4LTE2DQoNCiMgQ2hpZWYgQ29tcGxhaW50DQotIENoZXN0IFByZXNzdXJlDQoNCg0KIyBIaXN0b3J5IG9mIFByZXNlbnQgSWxsbmVzcw0KSGVyYmVydDgzMA0KIGlzIGEgMzUgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIHBhcnRpYWwgdGhpY2tuZXNzIGJ1cm4gKGRpc29yZGVyKSwgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCB1bmhlYWx0aHkgYWxjb2hvbCBkcmlua2luZyBiZWhhdmlvciAoZmluZGluZyksIHVuZW1wbG95ZWQgKGZpbmRpbmcpLCBnaW5naXZpdGlzIChkaXNvcmRlciksIHN0cmVzcyAoZmluZGluZyksIGJ1cm4gaW5qdXJ5IChtb3JwaG9sb2dpYyBhYm5vcm1hbGl0eSkuDQoNCiMgU29jaWFsIEhpc3RvcnkNClBhdGllbnQgaXMgbWFycmllZC4gUGF0aWVudCBxdWl0IHNtb2tpbmcgYXQgYWdlIDE2Lg0KIFBhdGllbnQgaWRlbnRpZmllcyBhcyBoZXRlcm9zZXh1YWwuDQoNClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuDQogUGF0aWVudCBoYXMgY29tcGxldGVkIHNvbWUgY29sbGVnZSBjb3Vyc2VzLg0KUGF0aWVudCBjdXJyZW50bHkgaGFzIEFudGhlbS4NCg0KIyBBbGxlcmdpZXMNCk5vIEtub3duIEFsbGVyZ2llcy4NCg0KIyBNZWRpY2F0aW9ucw0KbmRhMDIwOTgzIDIwMCBhY3R1YXQgYWxidXRlcm9sIDAuMDkgbWcvYWN0dWF0IG1ldGVyZWQgZG9zZSBpbmhhbGVyIFt2ZW50b2xpbl07IGFjZXRhbWlub3BoZW4gMzI1IG1nIC8gb3h5Y29kb25lIGh5ZHJvY2hsb3JpZGUgNSBtZyBvcmFsIHRhYmxldDsgY2VmZGluaXI7IG5hcHJveGVuIHNvZGl1bSAyMjAgbWcgb3JhbCB0YWJsZXQ7IGJ1ZGVzb25pZGUgMC4yNSBtZy9tbCBpbmhhbGF0aW9uIHN1c3BlbnNpb24NCg0KIyBBc3Nlc3NtZW50IGFuZCBQbGFuDQpQYXRpZW50IGlzIHByZXNlbnRpbmcgd2l0aCBnaW5naXZhbCBkaXNlYXNlIChkaXNvcmRlcikuIA0KDQoNCiMjIFBsYW4NCg0KVGhlIGZvbGxvd2luZyBwcm9jZWR1cmVzIHdlcmUgY29uZHVjdGVkOg0KLSBkZW50YWwgY29uc3VsdGF0aW9uIGFuZCByZXBvcnQgKHByb2NlZHVyZSkNCi0gZGVudGFsIGNhcmUgKHJlZ2ltZS90aGVyYXB5KQ0KLSByZW1vdmFsIG9mIHN1cHJhZ2luZ2l2YWwgcGxhcXVlIGFuZCBjYWxjdWx1cyBmcm9tIGFsbCB0ZWV0aCB1c2luZyBkZW50YWwgaW5zdHJ1bWVudCAocHJvY2VkdXJlKQ0KLSByZW1vdmFsIG9mIHN1YmdpbmdpdmFsIHBsYXF1ZSBhbmQgY2FsY3VsdXMgZnJvbSBhbGwgdGVldGggdXNpbmcgZGVudGFsIGluc3RydW1lbnQgKHByb2NlZHVyZSkNCi0gZGVudGFsIHBsYWluIHgtcmF5IGJpdGV3aW5nIChwcm9jZWR1cmUpDQotIGV4YW1pbmF0aW9uIG9mIGdpbmdpdmFlIChwcm9jZWR1cmUpDQotIGRlbnRhbCBzdXJnaWNhbCBwcm9jZWR1cmUgKHByb2NlZHVyZSkNCi0gZGVudGFsIGFwcGxpY2F0aW9uIG9mIGRlc2Vuc2l0aXppbmcgbWVkaWNhbWVudCAocHJvY2VkdXJlKQ0KLSBnaW5naXZlY3RvbXkgb3IgZ2luZ2l2b3BsYXN0eSwgcGVyIHRvb3RoIChwcm9jZWR1cmUpDQotIHBvc3RvcGVyYXRpdmUgY2FyZSBmb3IgZGVudGFsIHByb2NlZHVyZSAocmVnaW1lL3RoZXJhcHkpDQotIG9yYWwgaGVhbHRoIGVkdWNhdGlvbiAocHJvY2VkdXJlKQ0K" + }, + "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:5cf21de5-b7f3-0090-6719-d1ec48728e95" + } ], + "period": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:39b6bb14-b071-5a9d-cdb6-f51ad739e37e", + "resource": { + "resourceType": "Claim", + "id": "39b6bb14-b071-5a9d-cdb6-f51ad739e37e", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "created": "2015-08-16T14:45:07+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "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" + } ] + } + }, { + "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:a06dffbd-e266-8a2c-428d-9b57ae44a5c8" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:d1753e1b-62b8-c8c0-440c-0312d8fafa66" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:34521130-ee86-e7e7-e655-47cc3ba74800" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:43603b05-ba17-d526-8b5d-1379dbca2ca1" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:7aa5e536-8c0a-9a98-8f6a-232c3e8025af" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:266f1b6e-9b07-46b9-1f7a-3284e4e57fea" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:ea3013cb-b562-cf62-7933-aed5ef46ea8f" + } + }, { + "sequence": 7, + "procedureReference": { + "reference": "urn:uuid:311cc844-3ee7-4e52-c320-d22456ac98d1" + } + }, { + "sequence": 8, + "procedureReference": { + "reference": "urn:uuid:5007a435-6fc0-5537-3936-abf6dc98d0e8" + } + }, { + "sequence": 9, + "procedureReference": { + "reference": "urn:uuid:b23753f8-96fc-56b7-c06f-ae57183b901e" + } + }, { + "sequence": 10, + "procedureReference": { + "reference": "urn:uuid:969cb98c-207f-273e-f9cb-11f2f4ab0440" + } + }, { + "sequence": 11, + "procedureReference": { + "reference": "urn:uuid:d4f063c5-9383-c224-833e-bb62fc11c1a0" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185349003", + "display": "Encounter for check up (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + } ] + }, { + "sequence": 2, + "procedureSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 3, + "procedureSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 4, + "informationSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 5, + "informationSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 6, + "informationSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 7, + "procedureSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 8, + "procedureSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 9, + "informationSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 10, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 11, + "procedureSequence": [ 6 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 12, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "18718003", + "display": "Gingival disease (disorder)" + } ], + "text": "Gingival disease (disorder)" + } + }, { + "sequence": 13, + "informationSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225738002", + "display": "Operating room (environment)" + } ], + "text": "Operating room (environment)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 14, + "procedureSequence": [ 7 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "81733005", + "display": "Dental surgical procedure (procedure)" + } ], + "text": "Dental surgical procedure (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 15, + "procedureSequence": [ 8 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "3802001", + "display": "Dental application of desensitizing medicament (procedure)" + } ], + "text": "Dental application of desensitizing medicament (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 16, + "procedureSequence": [ 9 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "64544008", + "display": "Gingivectomy or gingivoplasty, per tooth (procedure)" + } ], + "text": "Gingivectomy or gingivoplasty, per tooth (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 17, + "procedureSequence": [ 10 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "456191000124101", + "display": "Postoperative care for dental procedure (regime/therapy)" + } ], + "text": "Postoperative care for dental procedure (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 18, + "procedureSequence": [ 11 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 4830.95, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:af0e7f6f-d5a2-0580-d877-6d8072cfba48", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "af0e7f6f-d5a2-0580-d877-6d8072cfba48", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "39b6bb14-b071-5a9d-cdb6-f51ad739e37e" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-08-16T14:45:07+01:00", + "end": "2016-08-16T14:45:07+01:00" + }, + "created": "2015-08-16T14:45:07+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:39b6bb14-b071-5a9d-cdb6-f51ad739e37e" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:a06dffbd-e266-8a2c-428d-9b57ae44a5c8" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + } ] + }, { + "sequence": 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": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": [ 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": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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, + "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": "18718003", + "display": "Gingival disease (disorder)" + } ], + "text": "Gingival disease (disorder)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + } + }, { + "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://snomed.info/sct", + "code": "225738002", + "display": "Operating room (environment)" + } ], + "text": "Operating room (environment)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "81733005", + "display": "Dental surgical procedure (procedure)" + } ], + "text": "Dental surgical procedure (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "3802001", + "display": "Dental application of desensitizing medicament (procedure)" + } ], + "text": "Dental application of desensitizing medicament (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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, + "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": "64544008", + "display": "Gingivectomy or gingivoplasty, per tooth (procedure)" + } ], + "text": "Gingivectomy or gingivoplasty, per tooth (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "456191000124101", + "display": "Postoperative care for dental procedure (regime/therapy)" + } ], + "text": "Postoperative care for dental procedure (regime/therapy)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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, + "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": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-16T08:41:58+01:00", + "end": "2015-08-16T14:45:07+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 4830.95, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 3796.3199999999993, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:0b706601-c94d-8c28-6ca6-44a057d1eb16", + "resource": { + "resourceType": "Encounter", + "id": "0b706601-c94d-8c28-6ca6-44a057d1eb16", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "0b706601-c94d-8c28-6ca6-44a057d1eb16" + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2015-08-22T08:41:58+01:00", + "end": "2015-08-22T08:56:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2015-08-22T08:41:58+01:00", + "end": "2015-08-22T08:56:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "403191005", + "display": "Partial thickness burn (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:6603439d-4d98-fe3a-2277-27069cf74af9", + "resource": { + "resourceType": "Condition", + "id": "6603439d-4d98-fe3a-2277-27069cf74af9", + "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": "307426000", + "display": "Acute infective cystitis (disorder)" + } ], + "text": "Acute infective cystitis (disorder)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0b706601-c94d-8c28-6ca6-44a057d1eb16" + }, + "onsetDateTime": "2015-12-08T08:41:58+01:00", + "abatementDateTime": "2015-12-10T10:07:48+01:00", + "recordedDate": "2015-12-08T08:41:58+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:39af7b26-a1d9-8a35-ede1-1edee1afd61d", + "resource": { + "resourceType": "DiagnosticReport", + "id": "39af7b26-a1d9-8a35-ede1-1edee1afd61d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0b706601-c94d-8c28-6ca6-44a057d1eb16" + }, + "effectiveDateTime": "2015-08-22T08:41:58+01:00", + "issued": "2015-08-22T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:89ffdfb4-268c-e2fb-3c5f-2555b3aaa4fa", + "resource": { + "resourceType": "DocumentReference", + "id": "89ffdfb4-268c-e2fb-3c5f-2555b3aaa4fa", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:39af7b26-a1d9-8a35-ede1-1edee1afd61d" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2015-08-22T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "content": [ { + "attachment": { + "contentType": "text/plain; charset=utf-8", + "data": "DQoyMDE1LTA4LTIyDQoNCiMgQ2hpZWYgQ29tcGxhaW50DQotIENoZXN0IFByZXNzdXJlDQoNCg0KIyBIaXN0b3J5IG9mIFByZXNlbnQgSWxsbmVzcw0KSGVyYmVydDgzMA0KIGlzIGEgMzUgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIGdpbmdpdmFsIGRpc2Vhc2UgKGRpc29yZGVyKSwgcGFydGlhbCB0aGlja25lc3MgYnVybiAoZGlzb3JkZXIpLCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIHVuaGVhbHRoeSBhbGNvaG9sIGRyaW5raW5nIGJlaGF2aW9yIChmaW5kaW5nKSwgdW5lbXBsb3llZCAoZmluZGluZyksIGdpbmdpdml0aXMgKGRpc29yZGVyKSwgc3RyZXNzIChmaW5kaW5nKSwgYnVybiBpbmp1cnkgKG1vcnBob2xvZ2ljIGFibm9ybWFsaXR5KS4NCg0KIyBTb2NpYWwgSGlzdG9yeQ0KUGF0aWVudCBpcyBtYXJyaWVkLiBQYXRpZW50IHF1aXQgc21va2luZyBhdCBhZ2UgMTYuDQogUGF0aWVudCBpZGVudGlmaWVzIGFzIGhldGVyb3NleHVhbC4NCg0KUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4NCiBQYXRpZW50IGhhcyBjb21wbGV0ZWQgc29tZSBjb2xsZWdlIGNvdXJzZXMuDQpQYXRpZW50IGN1cnJlbnRseSBoYXMgQW50aGVtLg0KDQojIEFsbGVyZ2llcw0KTm8gS25vd24gQWxsZXJnaWVzLg0KDQojIE1lZGljYXRpb25zDQpuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXTsgYWNldGFtaW5vcGhlbiAzMjUgbWcgLyBveHljb2RvbmUgaHlkcm9jaGxvcmlkZSA1IG1nIG9yYWwgdGFibGV0OyBjZWZkaW5pcjsgbmFwcm94ZW4gc29kaXVtIDIyMCBtZyBvcmFsIHRhYmxldDsgYnVkZXNvbmlkZSAwLjI1IG1nL21sIGluaGFsYXRpb24gc3VzcGVuc2lvbg0KDQojIEFzc2Vzc21lbnQgYW5kIFBsYW4NClBhdGllbnQgaXMgcHJlc2VudGluZyB3aXRoIGFjdXRlIGluZmVjdGl2ZSBjeXN0aXRpcyAoZGlzb3JkZXIpLiANCg0KDQojIyBQbGFuDQoNCg==" + }, + "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:0b706601-c94d-8c28-6ca6-44a057d1eb16" + } ], + "period": { + "start": "2015-08-22T08:41:58+01:00", + "end": "2015-08-22T08:56:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:e0f5d2cb-1ad3-c194-0ca9-12765cbe711a", + "resource": { + "resourceType": "Claim", + "id": "e0f5d2cb-1ad3-c194-0ca9-12765cbe711a", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2015-08-22T08:41:58+01:00", + "end": "2015-08-22T08:56:58+01:00" + }, + "created": "2015-08-22T08:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:6603439d-4d98-fe3a-2277-27069cf74af9" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185349003", + "display": "Encounter for check up (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:0b706601-c94d-8c28-6ca6-44a057d1eb16" + } ] + }, { + "sequence": 2, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "307426000", + "display": "Acute infective cystitis (disorder)" + } ], + "text": "Acute infective cystitis (disorder)" + } + } ], + "total": { + "value": 85.55, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:c20950c3-001e-7bdf-4630-a00cf728b61b", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "c20950c3-001e-7bdf-4630-a00cf728b61b", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "e0f5d2cb-1ad3-c194-0ca9-12765cbe711a" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-08-22T08:56:58+01:00", + "end": "2016-08-22T08:56:58+01:00" + }, + "created": "2015-08-22T08:56:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:e0f5d2cb-1ad3-c194-0ca9-12765cbe711a" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:6603439d-4d98-fe3a-2277-27069cf74af9" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "servicedPeriod": { + "start": "2015-08-22T08:41:58+01:00", + "end": "2015-08-22T08:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:0b706601-c94d-8c28-6ca6-44a057d1eb16" + } ] + }, { + "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": "307426000", + "display": "Acute infective cystitis (disorder)" + } ], + "text": "Acute infective cystitis (disorder)" + }, + "servicedPeriod": { + "start": "2015-08-22T08:41:58+01:00", + "end": "2015-08-22T08:56:58+01:00" + }, + "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:851fbf6a-2d4f-fbd0-1675-765ed47bf988", + "resource": { + "resourceType": "Encounter", + "id": "851fbf6a-2d4f-fbd0-1675-765ed47bf988", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "851fbf6a-2d4f-fbd0-1675-765ed47bf988" + } ], + "status": "finished", + "class": { + "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", + "code": "EMER" + }, + "type": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185345009", + "display": "Encounter for symptom (procedure)" + } ], + "text": "Encounter for symptom (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } + } ], + "period": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "307426000", + "display": "Acute infective cystitis (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:4d860c87-1fc9-f9ae-74b7-7b350d36843c", + "resource": { + "resourceType": "Observation", + "id": "4d860c87-1fc9-f9ae-74b7-7b350d36843c", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-clinical-test" ] + }, + "status": "final", + "category": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/observation-category", + "code": "exam", + "display": "Exam" + } ] + }, { + "coding": [ { + "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-observation-category", + "code": "clinical-test", + "display": "Clinical Test" + } ] + } ], + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "75636-1", + "display": "Emergency severity index" + } ], + "text": "Emergency severity index" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T09:20:24+01:00", + "issued": "2015-12-08T09:20:24.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA21754-9", + "display": "Needs 1 resource" + } ], + "text": "Needs 1 resource" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:8f144fd2-d06d-cbfd-b84a-dfdcbcf5f62d", + "resource": { + "resourceType": "Observation", + "id": "8f144fd2-d06d-cbfd-b84a-dfdcbcf5f62d", + "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" + } ], + "text": "Blood Pressure" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T09:20:24+01:00", + "issued": "2015-12-08T09:20:24.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "8462-4", + "display": "Diastolic Blood Pressure" + } ], + "text": "Diastolic Blood Pressure" + }, + "valueQuantity": { + "value": 74.936, + "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": 138.74, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:0ba23c6e-fa3d-e17f-a098-9f7a4f487b58", + "resource": { + "resourceType": "Observation", + "id": "0ba23c6e-fa3d-e17f-a098-9f7a4f487b58", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T09:20:24+01:00", + "issued": "2015-12-08T09:20:24.201+01:00", + "valueQuantity": { + "value": 69.23, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:f97b081e-162f-69d0-89a7-c5fe98345539", + "resource": { + "resourceType": "Observation", + "id": "f97b081e-162f-69d0-89a7-c5fe98345539", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T09:20:24+01:00", + "issued": "2015-12-08T09:20:24.201+01:00", + "valueQuantity": { + "value": 14.665, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:e85ab627-db67-8ced-93fd-4517ea8d5f40", + "resource": { + "resourceType": "Observation", + "id": "e85ab627-db67-8ced-93fd-4517ea8d5f40", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry" ] + }, + "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": "2708-6", + "display": "Oxygen saturation in Arterial blood" + }, { + "system": "http://loinc.org", + "code": "59408-5", + "display": "Oxygen saturation in Arterial blood by Pulse oximetry" + } ], + "text": "Oxygen saturation in Arterial blood" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T09:20:24+01:00", + "issued": "2015-12-08T09:20:24.201+01:00", + "valueQuantity": { + "value": 99.991, + "unit": "%", + "system": "http://unitsofmeasure.org", + "code": "%" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:8be87485-fcea-9364-f186-fdd1f53d0440", + "resource": { + "resourceType": "Observation", + "id": "8be87485-fcea-9364-f186-fdd1f53d0440", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T09:20:24+01:00", + "issued": "2015-12-08T09:20:24.201+01:00", + "valueQuantity": { + "value": 37.664, + "unit": "Cel", + "system": "http://unitsofmeasure.org", + "code": "Cel" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:3492ac8b-519c-5b34-e251-9a2c0d41330b", + "resource": { + "resourceType": "Observation", + "id": "3492ac8b-519c-5b34-e251-9a2c0d41330b", + "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": "5792-7", + "display": "Glucose [Mass/volume] in Urine by Test strip" + } ], + "text": "Glucose [Mass/volume] in Urine by Test strip" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueQuantity": { + "value": 5.7285, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:fd33ff3b-44cb-c8a5-3ec6-3728ff83b63c", + "resource": { + "resourceType": "Observation", + "id": "fd33ff3b-44cb-c8a5-3ec6-3728ff83b63c", + "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": "2514-8", + "display": "Ketones [Presence] in Urine by Test strip" + } ], + "text": "Ketones [Presence] in Urine by Test strip" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "167287002", + "display": "Urine ketones not detected (finding)" + } ], + "text": "Urine ketones not detected (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:0316867e-fbe5-2656-aa0b-5ea906fe39f7", + "resource": { + "resourceType": "Observation", + "id": "0316867e-fbe5-2656-aa0b-5ea906fe39f7", + "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": "5811-5", + "display": "Specific gravity of Urine by Test strip" + } ], + "text": "Specific gravity of Urine by Test strip" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueQuantity": { + "value": 1.0158, + "unit": "{nominal}", + "system": "http://unitsofmeasure.org", + "code": "{nominal}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:a8132d41-8f12-2ae5-1c6c-68c732556ea3", + "resource": { + "resourceType": "Observation", + "id": "a8132d41-8f12-2ae5-1c6c-68c732556ea3", + "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": "5803-2", + "display": "pH of Urine by Test strip" + } ], + "text": "pH of Urine by Test strip" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueQuantity": { + "value": 5.0554, + "unit": "pH", + "system": "http://unitsofmeasure.org", + "code": "pH" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:3fed1dfa-187b-a9b7-d93e-2b3e15758001", + "resource": { + "resourceType": "Observation", + "id": "3fed1dfa-187b-a9b7-d93e-2b3e15758001", + "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": "5804-0", + "display": "Protein [Mass/volume] in Urine by Test strip" + } ], + "text": "Protein [Mass/volume] in Urine by Test strip" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueQuantity": { + "value": 4.7319, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:5288618e-fb5c-4c5c-aac1-6018785a1c4c", + "resource": { + "resourceType": "Observation", + "id": "5288618e-fb5c-4c5c-aac1-6018785a1c4c", + "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": "5802-4", + "display": "Nitrite [Presence] in Urine by Test strip" + } ], + "text": "Nitrite [Presence] in Urine by Test strip" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "314137006", + "display": "Nitrite detected in urine (finding)" + } ], + "text": "Nitrite detected in urine (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:22d47c81-bc56-556b-24ab-609c4779d5f4", + "resource": { + "resourceType": "Observation", + "id": "22d47c81-bc56-556b-24ab-609c4779d5f4", + "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": "5794-3", + "display": "Hemoglobin [Presence] in Urine by Test strip" + } ], + "text": "Hemoglobin [Presence] in Urine by Test strip" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "167300001", + "display": "Urine blood test = + (finding)" + } ], + "text": "Urine blood test = + (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:0b9b4ac8-82b1-c77e-09d4-998f997f4828", + "resource": { + "resourceType": "Observation", + "id": "0b9b4ac8-82b1-c77e-09d4-998f997f4828", + "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": "5799-2", + "display": "Leukocyte esterase [Presence] in Urine by Test strip" + } ], + "text": "Leukocyte esterase [Presence] in Urine by Test strip" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394712000", + "display": "Urine leukocyte test one plus (finding)" + } ], + "text": "Urine leukocyte test one plus (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:6a638cca-dd08-05ce-6ee2-0047660d8e1b", + "resource": { + "resourceType": "Observation", + "id": "6a638cca-dd08-05ce-6ee2-0047660d8e1b", + "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": "5821-4", + "display": "WBCs" + } ], + "text": "WBCs" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueQuantity": { + "value": 13.144, + "unit": "/[HPF]", + "system": "http://unitsofmeasure.org", + "code": "/[HPF]" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:f59bc869-e84e-1654-aa5d-01fedcbc7e15", + "resource": { + "resourceType": "Observation", + "id": "f59bc869-e84e-1654-aa5d-01fedcbc7e15", + "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": "13945-1", + "display": "RBCs" + } ], + "text": "RBCs" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueQuantity": { + "value": 2.0183, + "unit": "/[HPF]", + "system": "http://unitsofmeasure.org", + "code": "/[HPF]" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c0d38ac3-ba6e-9329-cc18-f45bec0f6875", + "resource": { + "resourceType": "Observation", + "id": "c0d38ac3-ba6e-9329-cc18-f45bec0f6875", + "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": "5787-7", + "display": "Epithelial Cells" + } ], + "text": "Epithelial Cells" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueQuantity": { + "value": 3.4574, + "unit": "/[HPF]", + "system": "http://unitsofmeasure.org", + "code": "/[HPF]" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:82a9b9ae-a1f0-fd40-2f11-ebd805f75b6f", + "resource": { + "resourceType": "Observation", + "id": "82a9b9ae-a1f0-fd40-2f11-ebd805f75b6f", + "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": "24124-0", + "display": "Casts" + } ], + "text": "Casts" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "167336003", + "display": "Urine microscopy: no casts (finding)" + } ], + "text": "Urine microscopy: no casts (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:9063768e-ca8a-a9df-a59a-c391d82025dc", + "resource": { + "resourceType": "Observation", + "id": "9063768e-ca8a-a9df-a59a-c391d82025dc", + "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": "8247-9", + "display": "Mucus Threads" + } ], + "text": "Mucus Threads" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "276409005", + "display": "Mucus in urine (finding)" + } ], + "text": "Mucus in urine (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:88a37917-2353-1c3d-b077-4f85a7ea2f2e", + "resource": { + "resourceType": "Observation", + "id": "88a37917-2353-1c3d-b077-4f85a7ea2f2e", + "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": "5769-5", + "display": "Bacteria" + } ], + "text": "Bacteria" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "365691004", + "display": "Finding of presence of bacteria (finding)" + } ], + "text": "Finding of presence of bacteria (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:8cef5bb1-b1b7-d577-f4b1-e208cf008fa8", + "resource": { + "resourceType": "Observation", + "id": "8cef5bb1-b1b7-d577-f4b1-e208cf008fa8", + "status": "final", + "category": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/observation-category", + "code": "laboratory", + "display": "Laboratory" + } ] + } ], + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "630-4", + "display": "Bacteria identified in Urine by Culture" + } ], + "text": "Bacteria identified in Urine by Culture" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "valueString": "Greater than 100,000 colony forming units per mL Citrobacter freundii complex" + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:eea729c9-eb28-5c11-5928-ea4cd27b862f", + "resource": { + "resourceType": "Procedure", + "id": "eea729c9-eb28-5c11-5928-ea4cd27b862f", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "84100007", + "display": "History taking (procedure)" + } ], + "text": "History taking (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "performedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T08:48:30+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:2b833a90-7db9-06f4-0044-5f5ea094101c", + "resource": { + "resourceType": "Procedure", + "id": "2b833a90-7db9-06f4-0044-5f5ea094101c", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "223470000", + "display": "Discussion about signs and symptoms (procedure)" + } ], + "text": "Discussion about signs and symptoms (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "performedPeriod": { + "start": "2015-12-08T08:48:30+01:00", + "end": "2015-12-08T09:00:24+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:90390935-4a42-6935-3c63-93988adc609e", + "resource": { + "resourceType": "Procedure", + "id": "90390935-4a42-6935-3c63-93988adc609e", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "386478007", + "display": "Triage: emergency center (procedure)" + } ], + "text": "Triage: emergency center (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "performedPeriod": { + "start": "2015-12-08T09:00:24+01:00", + "end": "2015-12-08T09:15:24+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:5504b9cd-faf7-d455-6e03-5f0a1166cc98", + "resource": { + "resourceType": "Procedure", + "id": "5504b9cd-faf7-d455-6e03-5f0a1166cc98", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "61746007", + "display": "Taking patient vital signs (procedure)" + } ], + "text": "Taking patient vital signs (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "performedPeriod": { + "start": "2015-12-08T09:15:24+01:00", + "end": "2015-12-08T09:20:24+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:42f4fd25-424f-cc3e-4e89-fef6490d3de8", + "resource": { + "resourceType": "Procedure", + "id": "42f4fd25-424f-cc3e-4e89-fef6490d3de8", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "14736009", + "display": "History and physical examination with evaluation and management of patient (procedure)" + } ], + "text": "History and physical examination with evaluation and management of patient (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "performedPeriod": { + "start": "2015-12-08T09:20:24+01:00", + "end": "2015-12-08T10:17:48+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:1052fd28-2e5c-28b8-1aff-2467cb9d7f59", + "resource": { + "resourceType": "Procedure", + "id": "1052fd28-2e5c-28b8-1aff-2467cb9d7f59", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "441550005", + "display": "Urinalysis with reflex to microscopy and culture (procedure)" + } ], + "text": "Urinalysis with reflex to microscopy and culture (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "performedPeriod": { + "start": "2015-12-08T10:17:48+01:00", + "end": "2015-12-08T10:27:48+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:fa6f82ac-e0ed-3288-4ced-b043a18deb41", + "resource": { + "resourceType": "Procedure", + "id": "fa6f82ac-e0ed-3288-4ced-b043a18deb41", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "57617002", + "display": "Urine specimen collection (procedure)" + } ], + "text": "Urine specimen collection (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "performedPeriod": { + "start": "2015-12-08T10:27:48+01:00", + "end": "2015-12-08T10:37:48+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:2d228426-264e-8d6c-9837-e28a83bece54", + "resource": { + "resourceType": "Procedure", + "id": "2d228426-264e-8d6c-9837-e28a83bece54", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "441550005", + "display": "Urinalysis with reflex to microscopy and culture (procedure)" + } ], + "text": "Urinalysis with reflex to microscopy and culture (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "performedPeriod": { + "start": "2015-12-08T10:37:48+01:00", + "end": "2015-12-08T10:47:48+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:b61b0b79-a692-79f0-3d37-69c9aeead0a1", + "resource": { + "resourceType": "Procedure", + "id": "b61b0b79-a692-79f0-3d37-69c9aeead0a1", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "281789004", + "display": "Antibiotic therapy (procedure)" + } ], + "text": "Antibiotic therapy (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "performedPeriod": { + "start": "2015-12-08T10:47:48+01:00", + "end": "2015-12-08T10:57:48+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:97c09fb6-a348-0137-ce7c-9fe1fb385dbd", + "resource": { + "resourceType": "Procedure", + "id": "97c09fb6-a348-0137-ce7c-9fe1fb385dbd", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "58000006", + "display": "Patient discharge (procedure)" + } ], + "text": "Patient discharge (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "performedPeriod": { + "start": "2015-12-08T10:57:48+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:eb27435d-1db6-d004-a944-8fdc31c36428", + "resource": { + "resourceType": "MedicationRequest", + "id": "eb27435d-1db6-d004-a944-8fdc31c36428", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "309309", + "display": "ciprofloxacin 500 MG Oral Tablet" + } ], + "text": "ciprofloxacin 500 MG Oral Tablet" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "authoredOn": "2015-12-08T10:57:48+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + }, + "reasonReference": [ { + "reference": "urn:uuid:6603439d-4d98-fe3a-2277-27069cf74af9", + "display": "Acute infective cystitis (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "timing": { + "repeat": { + "frequency": 2, + "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:170648e1-4ca5-1aa6-25c2-458704db9e8e", + "resource": { + "resourceType": "Claim", + "id": "170648e1-4ca5-1aa6-25c2-458704db9e8e", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "created": "2015-12-08T11:07:48+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:eb27435d-1db6-d004-a944-8fdc31c36428" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "309309", + "display": "ciprofloxacin 500 MG Oral Tablet" + } ], + "text": "ciprofloxacin 500 MG Oral Tablet" + }, + "encounter": [ { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:afc50dd6-81cf-c3c6-b9aa-45ada3de52a7", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "afc50dd6-81cf-c3c6-b9aa-45ada3de52a7", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "170648e1-4ca5-1aa6-25c2-458704db9e8e" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-12-08T11:07:48+01:00", + "end": "2016-12-08T11:07:48+01:00" + }, + "created": "2015-12-08T11:07:48+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "claim": { + "reference": "urn:uuid:170648e1-4ca5-1aa6-25c2-458704db9e8e" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "309309", + "display": "ciprofloxacin 500 MG Oral Tablet" + } ], + "text": "ciprofloxacin 500 MG Oral Tablet" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:ee38fae0-28a6-d0f1-27d7-be6fabf60911", + "resource": { + "resourceType": "DiagnosticReport", + "id": "ee38fae0-28a6-d0f1-27d7-be6fabf60911", + "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": "24357-6", + "display": "Urinalysis macro (dipstick) panel - Urine" + } ], + "text": "Urinalysis macro (dipstick) panel - Urine" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T10:47:48+01:00", + "issued": "2015-12-08T10:47:48.201+01:00", + "performer": [ { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } ], + "result": [ { + "reference": "urn:uuid:3492ac8b-519c-5b34-e251-9a2c0d41330b", + "display": "Glucose [Mass/volume] in Urine by Test strip" + }, { + "reference": "urn:uuid:fd33ff3b-44cb-c8a5-3ec6-3728ff83b63c", + "display": "Ketones [Presence] in Urine by Test strip" + }, { + "reference": "urn:uuid:0316867e-fbe5-2656-aa0b-5ea906fe39f7", + "display": "Specific gravity of Urine by Test strip" + }, { + "reference": "urn:uuid:a8132d41-8f12-2ae5-1c6c-68c732556ea3", + "display": "pH of Urine by Test strip" + }, { + "reference": "urn:uuid:3fed1dfa-187b-a9b7-d93e-2b3e15758001", + "display": "Protein [Mass/volume] in Urine by Test strip" + }, { + "reference": "urn:uuid:5288618e-fb5c-4c5c-aac1-6018785a1c4c", + "display": "Nitrite [Presence] in Urine by Test strip" + }, { + "reference": "urn:uuid:22d47c81-bc56-556b-24ab-609c4779d5f4", + "display": "Hemoglobin [Presence] in Urine by Test strip" + }, { + "reference": "urn:uuid:0b9b4ac8-82b1-c77e-09d4-998f997f4828", + "display": "Leukocyte esterase [Presence] in Urine by Test strip" + }, { + "reference": "urn:uuid:6a638cca-dd08-05ce-6ee2-0047660d8e1b", + "display": "WBCs" + }, { + "reference": "urn:uuid:f59bc869-e84e-1654-aa5d-01fedcbc7e15", + "display": "RBCs" + }, { + "reference": "urn:uuid:c0d38ac3-ba6e-9329-cc18-f45bec0f6875", + "display": "Epithelial Cells" + }, { + "reference": "urn:uuid:82a9b9ae-a1f0-fd40-2f11-ebd805f75b6f", + "display": "Casts" + }, { + "reference": "urn:uuid:9063768e-ca8a-a9df-a59a-c391d82025dc", + "display": "Mucus Threads" + }, { + "reference": "urn:uuid:88a37917-2353-1c3d-b077-4f85a7ea2f2e", + "display": "Bacteria" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:105cf80d-085c-8425-deeb-d90c618c26f5", + "resource": { + "resourceType": "DiagnosticReport", + "id": "105cf80d-085c-8425-deeb-d90c618c26f5", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, + "effectiveDateTime": "2015-12-08T08:41:58+01:00", + "issued": "2015-12-08T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:9cf8c364-b7fd-9139-1a0f-49992f058c03", + "resource": { + "resourceType": "DocumentReference", + "id": "9cf8c364-b7fd-9139-1a0f-49992f058c03", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:105cf80d-085c-8425-deeb-d90c618c26f5" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2015-12-08T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "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:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + } ], + "period": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:523a0884-452e-141b-17d4-79e892b95804", + "resource": { + "resourceType": "Claim", + "id": "523a0884-452e-141b-17d4-79e892b95804", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "institutional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "created": "2015-12-08T11:07:48+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:eea729c9-eb28-5c11-5928-ea4cd27b862f" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:2b833a90-7db9-06f4-0044-5f5ea094101c" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:90390935-4a42-6935-3c63-93988adc609e" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:5504b9cd-faf7-d455-6e03-5f0a1166cc98" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:42f4fd25-424f-cc3e-4e89-fef6490d3de8" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:1052fd28-2e5c-28b8-1aff-2467cb9d7f59" + } + }, { + "sequence": 7, + "procedureReference": { + "reference": "urn:uuid:fa6f82ac-e0ed-3288-4ced-b043a18deb41" + } + }, { + "sequence": 8, + "procedureReference": { + "reference": "urn:uuid:2d228426-264e-8d6c-9837-e28a83bece54" + } + }, { + "sequence": 9, + "procedureReference": { + "reference": "urn:uuid:b61b0b79-a692-79f0-3d37-69c9aeead0a1" + } + }, { + "sequence": 10, + "procedureReference": { + "reference": "urn:uuid:97c09fb6-a348-0137-ce7c-9fe1fb385dbd" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185345009", + "display": "Encounter for symptom (procedure)" + } ], + "text": "Encounter for symptom (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + } ] + }, { + "sequence": 2, + "procedureSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "84100007", + "display": "History taking (procedure)" + } ], + "text": "History taking (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 3, + "procedureSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "223470000", + "display": "Discussion about signs and symptoms (procedure)" + } ], + "text": "Discussion about signs and symptoms (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 4, + "procedureSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "386478007", + "display": "Triage: emergency center (procedure)" + } ], + "text": "Triage: emergency center (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 5, + "procedureSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "61746007", + "display": "Taking patient vital signs (procedure)" + } ], + "text": "Taking patient vital signs (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 6, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "14736009", + "display": "History and physical examination with evaluation and management of patient (procedure)" + } ], + "text": "History and physical examination with evaluation and management of patient (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 7, + "procedureSequence": [ 6 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "441550005", + "display": "Urinalysis with reflex to microscopy and culture (procedure)" + } ], + "text": "Urinalysis with reflex to microscopy and culture (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 8, + "procedureSequence": [ 7 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "57617002", + "display": "Urine specimen collection (procedure)" + } ], + "text": "Urine specimen collection (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 9, + "procedureSequence": [ 8 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "441550005", + "display": "Urinalysis with reflex to microscopy and culture (procedure)" + } ], + "text": "Urinalysis with reflex to microscopy and culture (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 10, + "informationSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "24357-6", + "display": "Urinalysis macro (dipstick) panel - Urine" + } ], + "text": "Urinalysis macro (dipstick) panel - Urine" + }, + "net": { + "value": 74.58, + "currency": "USD" + } + }, { + "sequence": 11, + "procedureSequence": [ 9 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "281789004", + "display": "Antibiotic therapy (procedure)" + } ], + "text": "Antibiotic therapy (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 12, + "procedureSequence": [ 10 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "58000006", + "display": "Patient discharge (procedure)" + } ], + "text": "Patient discharge (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 4476.29, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:4c25335f-2bef-6c67-8e9e-805c3c93101f", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "4c25335f-2bef-6c67-8e9e-805c3c93101f", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "523a0884-452e-141b-17d4-79e892b95804" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2015-12-08T11:07:48+01:00", + "end": "2016-12-08T11:07:48+01:00" + }, + "created": "2015-12-08T11:07:48+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "claim": { + "reference": "urn:uuid:523a0884-452e-141b-17d4-79e892b95804" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for symptom (procedure)" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + } ] + }, { + "sequence": 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": "84100007", + "display": "History taking (procedure)" + } ], + "text": "History taking (procedure)" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "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": 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": "223470000", + "display": "Discussion about signs and symptoms (procedure)" + } ], + "text": "Discussion about signs and symptoms (procedure)" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "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": 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": "386478007", + "display": "Triage: emergency center (procedure)" + } ], + "text": "Triage: emergency center (procedure)" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 5, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "61746007", + "display": "Taking patient vital signs (procedure)" + } ], + "text": "Taking patient vital signs (procedure)" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 6, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "14736009", + "display": "History and physical examination with evaluation and management of patient (procedure)" + } ], + "text": "History and physical examination with evaluation and management of patient (procedure)" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "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": "441550005", + "display": "Urinalysis with reflex to microscopy and culture (procedure)" + } ], + "text": "Urinalysis with reflex to microscopy and culture (procedure)" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "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": "57617002", + "display": "Urine specimen collection (procedure)" + } ], + "text": "Urine specimen collection (procedure)" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "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": "441550005", + "display": "Urinalysis with reflex to microscopy and culture (procedure)" + } ], + "text": "Urinalysis with reflex to microscopy and culture (procedure)" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "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": [ 1 ], + "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": "24357-6", + "display": "Urinalysis macro (dipstick) panel - Urine" + } ], + "text": "Urinalysis macro (dipstick) panel - Urine" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "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": "281789004", + "display": "Antibiotic therapy (procedure)" + } ], + "text": "Antibiotic therapy (procedure)" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "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": "58000006", + "display": "Patient discharge (procedure)" + } ], + "text": "Patient discharge (procedure)" + }, + "servicedPeriod": { + "start": "2015-12-08T08:41:58+01:00", + "end": "2015-12-08T11:07:48+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 4476.29, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 3510.8639999999996, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a", + "resource": { + "resourceType": "Encounter", + "id": "cd33cf82-0c6b-df4a-4383-f683e5e2817a", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "cd33cf82-0c6b-df4a-4383-f683e5e2817a" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:4487f6cb-dc89-9ac5-f4f4-88f50ed543eb", + "resource": { + "resourceType": "Condition", + "id": "4487f6cb-dc89-9ac5-f4f4-88f50ed543eb", + "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": "422650009", + "display": "Social isolation (finding)" + } ], + "text": "Social isolation (finding)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "onsetDateTime": "2016-07-31T09:16:25+01:00", + "abatementDateTime": "2017-08-06T09:31:57+01:00", + "recordedDate": "2016-07-31T09:16:25+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:d97ef5bf-7e94-5cc5-c2e9-230dae199eed", + "resource": { + "resourceType": "Observation", + "id": "d97ef5bf-7e94-5cc5-c2e9-230dae199eed", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 168.8, + "unit": "cm", + "system": "http://unitsofmeasure.org", + "code": "cm" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:d25f8fd0-d58f-acd0-2cd7-d3e5d6c1c79b", + "resource": { + "resourceType": "Observation", + "id": "d25f8fd0-d58f-acd0-2cd7-d3e5d6c1c79b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:4b0d7c13-a3b2-4fe8-3010-323f399cc5e1", + "resource": { + "resourceType": "Observation", + "id": "4b0d7c13-a3b2-4fe8-3010-323f399cc5e1", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 86.8, + "unit": "kg", + "system": "http://unitsofmeasure.org", + "code": "kg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:ec714d5e-0e42-5b8b-c144-4dccda462c7a", + "resource": { + "resourceType": "Observation", + "id": "ec714d5e-0e42-5b8b-c144-4dccda462c7a", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 30.46, + "unit": "kg/m2", + "system": "http://unitsofmeasure.org", + "code": "kg/m2" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:4c46f45b-75ce-c956-6178-82d720577771", + "resource": { + "resourceType": "Observation", + "id": "4c46f45b-75ce-c956-6178-82d720577771", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "8462-4", + "display": "Diastolic Blood Pressure" + } ], + "text": "Diastolic Blood Pressure" + }, + "valueQuantity": { + "value": 85, + "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": 106, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:679dddb0-bf21-e77c-193d-f6597c2c2c29", + "resource": { + "resourceType": "Observation", + "id": "679dddb0-bf21-e77c-193d-f6597c2c2c29", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 62, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:ff1be34b-0db8-7bec-11e0-f1553ab1bc82", + "resource": { + "resourceType": "Observation", + "id": "ff1be34b-0db8-7bec-11e0-f1553ab1bc82", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 14, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:4fdc5840-9e5a-97d4-c8f0-1ed97ce02cbb", + "resource": { + "resourceType": "Observation", + "id": "4fdc5840-9e5a-97d4-c8f0-1ed97ce02cbb", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 129.79, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:5a2ea033-9008-9b9d-0017-3b936d449271", + "resource": { + "resourceType": "Observation", + "id": "5a2ea033-9008-9b9d-0017-3b936d449271", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 102.89, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:e3a54d65-f1b6-0821-0d5a-472c0900dd6e", + "resource": { + "resourceType": "Observation", + "id": "e3a54d65-f1b6-0821-0d5a-472c0900dd6e", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 53.54, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:955c6548-5841-a9b6-cc15-6d0245c3a452", + "resource": { + "resourceType": "Observation", + "id": "955c6548-5841-a9b6-cc15-6d0245c3a452", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 55.67, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:07149a54-fd80-bdf5-c235-76845f4bf27c", + "resource": { + "resourceType": "Observation", + "id": "07149a54-fd80-bdf5-c235-76845f4bf27c", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 5.3176, + "unit": "10*3/uL", + "system": "http://unitsofmeasure.org", + "code": "10*3/uL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:85daa5ab-6f52-488b-cc7c-7ff14046cacb", + "resource": { + "resourceType": "Observation", + "id": "85daa5ab-6f52-488b-cc7c-7ff14046cacb", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 4.9766, + "unit": "10*6/uL", + "system": "http://unitsofmeasure.org", + "code": "10*6/uL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:98194fae-a73a-3780-d8f1-3b4921b54084", + "resource": { + "resourceType": "Observation", + "id": "98194fae-a73a-3780-d8f1-3b4921b54084", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 13.667, + "unit": "g/dL", + "system": "http://unitsofmeasure.org", + "code": "g/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:4a0c9578-4ba9-4ef6-b532-e82ac22b64db", + "resource": { + "resourceType": "Observation", + "id": "4a0c9578-4ba9-4ef6-b532-e82ac22b64db", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 35.638, + "unit": "%", + "system": "http://unitsofmeasure.org", + "code": "%" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:a19f0b23-9b49-7d0f-f6d6-85638a80ff49", + "resource": { + "resourceType": "Observation", + "id": "a19f0b23-9b49-7d0f-f6d6-85638a80ff49", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 82.425, + "unit": "fL", + "system": "http://unitsofmeasure.org", + "code": "fL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:48f085bb-d0e6-118e-0fa9-568cfcd0bc14", + "resource": { + "resourceType": "Observation", + "id": "48f085bb-d0e6-118e-0fa9-568cfcd0bc14", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 27.442, + "unit": "pg", + "system": "http://unitsofmeasure.org", + "code": "pg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:f85164ff-c826-fb64-13e8-43d7039fe174", + "resource": { + "resourceType": "Observation", + "id": "f85164ff-c826-fb64-13e8-43d7039fe174", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 33.555, + "unit": "g/dL", + "system": "http://unitsofmeasure.org", + "code": "g/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:b29605c2-16d8-c4e1-ee15-0a673e927eb7", + "resource": { + "resourceType": "Observation", + "id": "b29605c2-16d8-c4e1-ee15-0a673e927eb7", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 41.742, + "unit": "fL", + "system": "http://unitsofmeasure.org", + "code": "fL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:3c85608e-465e-0171-e78c-40d74bef2d29", + "resource": { + "resourceType": "Observation", + "id": "3c85608e-465e-0171-e78c-40d74bef2d29", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 164.94, + "unit": "10*3/uL", + "system": "http://unitsofmeasure.org", + "code": "10*3/uL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:6d2b79da-a22c-083c-dc9a-d6b067257cb9", + "resource": { + "resourceType": "Observation", + "id": "6d2b79da-a22c-083c-dc9a-d6b067257cb9", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 448.88, + "unit": "fL", + "system": "http://unitsofmeasure.org", + "code": "fL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:eec2dff5-2bfa-bd00-d5f2-3f032bb4168b", + "resource": { + "resourceType": "Observation", + "id": "eec2dff5-2bfa-bd00-d5f2-3f032bb4168b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueQuantity": { + "value": 11.639, + "unit": "fL", + "system": "http://unitsofmeasure.org", + "code": "fL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:48c8b560-d190-0df3-d811-beb8ec9b1972", + "resource": { + "resourceType": "Observation", + "id": "48c8b560-d190-0df3-d811-beb8ec9b1972", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "8517006", + "display": "Ex-smoker (finding)" + } ], + "text": "Ex-smoker (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:70da53c7-205c-e452-91ed-7c7574edc3f7", + "resource": { + "resourceType": "Observation", + "id": "70da53c7-205c-e452-91ed-7c7574edc3f7", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T09:16:25+01:00", + "issued": "2016-07-31T09:16:25.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "76501-6", + "display": "Within the last year, have you been afraid of your partner or ex-partner?" + } ], + "text": "Within the last year, have you been afraid of your partner or ex-partner?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93026-3", + "display": "Do you feel physically and emotionally safe where you currently live?" + } ], + "text": "Do you feel physically and emotionally safe where you currently live?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA33-6", + "display": "Yes" + } ], + "text": "Yes" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93027-1", + "display": "Are you a refugee?" + } ], + "text": "Are you a refugee?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93028-9", + "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + } ], + "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93038-8", + "display": "Stress level" + } ], + "text": "Stress level" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA6568-5", + "display": "Not at all" + } ], + "text": "Not at all" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93029-7", + "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + } ], + "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA27722-0", + "display": "Less than once a week" + } ], + "text": "Less than once a week" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93030-5", + "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + } ], + "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93031-3", + "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + } ], + "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30125-1", + "display": "Food" + } ], + "text": "Food" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63586-2", + "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + } ], + "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + }, + "valueQuantity": { + "value": 60262, + "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": "LA17956-6", + "display": "Unemployed" + } ], + "text": "Unemployed" + } + }, { + "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": "627 Ullrich Dam Unit 88" + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93033-9", + "display": "Are you worried about losing your housing?" + } ], + "text": "Are you worried about losing your housing?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "71802-3", + "display": "Housing status" + } ], + "text": "Housing status" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30189-7", + "display": "I have housing" + } ], + "text": "I have housing" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63512-8", + "display": "How many people are living or staying at this address?" + } ], + "text": "How many people are living or staying at this address?" + }, + "valueQuantity": { + "value": 7, + "unit": "{#}", + "system": "http://unitsofmeasure.org", + "code": "{#}" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "54899-0", + "display": "Preferred language" + } ], + "text": "Preferred language" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA43-5", + "display": "English" + } ], + "text": "English" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93034-7", + "display": "Have you been discharged from the armed forces of the United States?" + } ], + "text": "Have you been discharged from the armed forces of the United States?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93035-4", + "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + } ], + "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "32624-9", + "display": "Race" + } ], + "text": "Race" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA4457-3", + "display": "White" + } ], + "text": "White" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "56051-6", + "display": "Do you consider yourself Hispanic/Latino?" + } ], + "text": "Do you consider yourself Hispanic/Latino?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:ae6a5577-d5ad-027f-752a-b6e50eee3e75", + "resource": { + "resourceType": "Observation", + "id": "ae6a5577-d5ad-027f-752a-b6e50eee3e75", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T09:52:29+01:00", + "issued": "2016-07-31T09:52:29.201+01:00", + "valueQuantity": { + "value": 2, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:16fb72cf-f392-a04d-d466-04add07529fe", + "resource": { + "resourceType": "Observation", + "id": "16fb72cf-f392-a04d-d466-04add07529fe", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T10:33:21+01:00", + "issued": "2016-07-31T10:33:21.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:84569152-4783-57a2-adb1-51e5a869d491", + "resource": { + "resourceType": "Procedure", + "id": "84569152-4783-57a2-adb1-51e5a869d491", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "performedPeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:c5c7dc03-b2c8-6e63-c774-24a733d1fc4b", + "resource": { + "resourceType": "Procedure", + "id": "c5c7dc03-b2c8-6e63-c774-24a733d1fc4b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "performedPeriod": { + "start": "2016-07-31T09:16:25+01:00", + "end": "2016-07-31T09:31:17+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:700cc5a4-c22e-89b0-3f34-4201c9905a8a", + "resource": { + "resourceType": "Procedure", + "id": "700cc5a4-c22e-89b0-3f34-4201c9905a8a", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "performedPeriod": { + "start": "2016-07-31T09:31:17+01:00", + "end": "2016-07-31T09:52:29+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:9acc4703-30ee-2016-0848-8f51545444d0", + "resource": { + "resourceType": "Procedure", + "id": "9acc4703-30ee-2016-0848-8f51545444d0", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "performedPeriod": { + "start": "2016-07-31T09:52:29+01:00", + "end": "2016-07-31T10:03:39+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:ec46d574-b248-53f7-265a-d63d56092da7", + "resource": { + "resourceType": "Procedure", + "id": "ec46d574-b248-53f7-265a-d63d56092da7", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "performedPeriod": { + "start": "2016-07-31T10:03:39+01:00", + "end": "2016-07-31T10:33:21+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:5266d71c-9baa-d76e-1069-88aede6fcf33", + "resource": { + "resourceType": "Procedure", + "id": "5266d71c-9baa-d76e-1069-88aede6fcf33", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "performedPeriod": { + "start": "2016-07-31T10:33:21+01:00", + "end": "2016-07-31T10:49:55+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:78ffd255-4b7a-106f-f1e2-207e2612f00d", + "resource": { + "resourceType": "MedicationRequest", + "id": "78ffd255-4b7a-106f-f1e2-207e2612f00d", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "authoredOn": "2016-07-31T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:a2c75668-b4ba-9158-f382-3836e4e54e6a", + "resource": { + "resourceType": "Claim", + "id": "a2c75668-b4ba-9158-f382-3836e4e54e6a", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "created": "2016-07-31T09:16:25+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:78ffd255-4b7a-106f-f1e2-207e2612f00d" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "encounter": [ { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:2d2494f9-0620-f5e4-32bc-025a4d686669", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "2d2494f9-0620-f5e4-32bc-025a4d686669", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "a2c75668-b4ba-9158-f382-3836e4e54e6a" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2016-07-31T09:16:25+01:00", + "end": "2017-07-31T09:16:25+01:00" + }, + "created": "2016-07-31T09:16:25+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:a2c75668-b4ba-9158-f382-3836e4e54e6a" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "servicedPeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:c11834df-ed71-2486-ecd2-b6f73248ff7e", + "resource": { + "resourceType": "MedicationRequest", + "id": "c11834df-ed71-2486-ecd2-b6f73248ff7e", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "authoredOn": "2016-07-31T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:7eccd987-26ac-b372-114f-4ed60533f313", + "resource": { + "resourceType": "Claim", + "id": "7eccd987-26ac-b372-114f-4ed60533f313", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "created": "2016-07-31T09:16:25+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:c11834df-ed71-2486-ecd2-b6f73248ff7e" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "encounter": [ { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:c19c1200-6e3c-209b-653f-ca42f107d74c", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "c19c1200-6e3c-209b-653f-ca42f107d74c", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "7eccd987-26ac-b372-114f-4ed60533f313" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2016-07-31T09:16:25+01:00", + "end": "2017-07-31T09:16:25+01:00" + }, + "created": "2016-07-31T09:16:25+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:7eccd987-26ac-b372-114f-4ed60533f313" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "servicedPeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:300e9311-6442-573f-764b-9f7d767a7a07", + "resource": { + "resourceType": "Immunization", + "id": "300e9311-6442-573f-764b-9f7d767a7a07", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "occurrenceDateTime": "2016-07-31T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:a786da51-2c96-ef6b-4046-4419f45d9770", + "resource": { + "resourceType": "DiagnosticReport", + "id": "a786da51-2c96-ef6b-4046-4419f45d9770", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "performer": [ { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } ], + "result": [ { + "reference": "urn:uuid:4fdc5840-9e5a-97d4-c8f0-1ed97ce02cbb", + "display": "Cholesterol [Mass/volume] in Serum or Plasma" + }, { + "reference": "urn:uuid:5a2ea033-9008-9b9d-0017-3b936d449271", + "display": "Triglycerides" + }, { + "reference": "urn:uuid:e3a54d65-f1b6-0821-0d5a-472c0900dd6e", + "display": "Low Density Lipoprotein Cholesterol" + }, { + "reference": "urn:uuid:955c6548-5841-a9b6-cc15-6d0245c3a452", + "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:dea5b59a-6c2f-1b43-0700-505acb3fdcf4", + "resource": { + "resourceType": "DiagnosticReport", + "id": "dea5b59a-6c2f-1b43-0700-505acb3fdcf4", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "performer": [ { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } ], + "result": [ { + "reference": "urn:uuid:07149a54-fd80-bdf5-c235-76845f4bf27c", + "display": "Leukocytes [#/volume] in Blood by Automated count" + }, { + "reference": "urn:uuid:85daa5ab-6f52-488b-cc7c-7ff14046cacb", + "display": "Erythrocytes [#/volume] in Blood by Automated count" + }, { + "reference": "urn:uuid:98194fae-a73a-3780-d8f1-3b4921b54084", + "display": "Hemoglobin [Mass/volume] in Blood" + }, { + "reference": "urn:uuid:4a0c9578-4ba9-4ef6-b532-e82ac22b64db", + "display": "Hematocrit [Volume Fraction] of Blood by Automated count" + }, { + "reference": "urn:uuid:a19f0b23-9b49-7d0f-f6d6-85638a80ff49", + "display": "MCV [Entitic volume] by Automated count" + }, { + "reference": "urn:uuid:48f085bb-d0e6-118e-0fa9-568cfcd0bc14", + "display": "MCH [Entitic mass] by Automated count" + }, { + "reference": "urn:uuid:f85164ff-c826-fb64-13e8-43d7039fe174", + "display": "MCHC [Mass/volume] by Automated count" + }, { + "reference": "urn:uuid:b29605c2-16d8-c4e1-ee15-0a673e927eb7", + "display": "Erythrocyte distribution width [Entitic volume] by Automated count" + }, { + "reference": "urn:uuid:3c85608e-465e-0171-e78c-40d74bef2d29", + "display": "Platelets [#/volume] in Blood by Automated count" + }, { + "reference": "urn:uuid:6d2b79da-a22c-083c-dc9a-d6b067257cb9", + "display": "Platelet distribution width [Entitic volume] in Blood by Automated count" + }, { + "reference": "urn:uuid:eec2dff5-2bfa-bd00-d5f2-3f032bb4168b", + "display": "Platelet mean volume [Entitic volume] in Blood by Automated count" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:026fba8b-ee95-f843-2089-11481a6667fb", + "resource": { + "resourceType": "DiagnosticReport", + "id": "026fba8b-ee95-f843-2089-11481a6667fb", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T09:52:29+01:00", + "issued": "2016-07-31T09:52:29.201+01:00", + "result": [ { + "reference": "urn:uuid:ae6a5577-d5ad-027f-752a-b6e50eee3e75", + "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:c6aa5133-e54a-fb02-3669-4b46462391b8", + "resource": { + "resourceType": "DiagnosticReport", + "id": "c6aa5133-e54a-fb02-3669-4b46462391b8", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T10:33:21+01:00", + "issued": "2016-07-31T10:33:21.201+01:00", + "result": [ { + "reference": "urn:uuid:16fb72cf-f392-a04d-d466-04add07529fe", + "display": "Total score [DAST-10]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:452d53ae-0850-bacf-9e5c-f67ed6df9bce", + "resource": { + "resourceType": "DiagnosticReport", + "id": "452d53ae-0850-bacf-9e5c-f67ed6df9bce", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, + "effectiveDateTime": "2016-07-31T08:41:58+01:00", + "issued": "2016-07-31T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:26085ea0-2375-0b24-9d10-5969a08b9158", + "resource": { + "resourceType": "DocumentReference", + "id": "26085ea0-2375-0b24-9d10-5969a08b9158", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:452d53ae-0850-bacf-9e5c-f67ed6df9bce" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2016-07-31T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + } ], + "period": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:4098305a-1858-11f8-c94b-bcdc10593052", + "resource": { + "resourceType": "Claim", + "id": "4098305a-1858-11f8-c94b-bcdc10593052", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "created": "2016-07-31T09:16:25+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:300e9311-6442-573f-764b-9f7d767a7a07" + } + }, { + "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:4487f6cb-dc89-9ac5-f4f4-88f50ed543eb" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:84569152-4783-57a2-adb1-51e5a869d491" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:c5c7dc03-b2c8-6e63-c774-24a733d1fc4b" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:700cc5a4-c22e-89b0-3f34-4201c9905a8a" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:9acc4703-30ee-2016-0848-8f51545444d0" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:ec46d574-b248-53f7-265a-d63d56092da7" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:5266d71c-9baa-d76e-1069-88aede6fcf33" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "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:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + } ] + }, { + "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://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": 4, + "informationSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "58410-2", + "display": "CBC panel - Blood by Automated count" + } ], + "text": "CBC panel - Blood by Automated count" + }, + "net": { + "value": 74.58, + "currency": "USD" + } + }, { + "sequence": 5, + "procedureSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 6, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "422650009", + "display": "Social isolation (finding)" + } ], + "text": "Social isolation (finding)" + } + }, { + "sequence": 7, + "procedureSequence": [ 2 ], + "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": [ 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, + "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": 10, + "procedureSequence": [ 4 ], + "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": [ 5 ], + "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": [ 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" + } + }, { + "sequence": 13, + "procedureSequence": [ 6 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 853.36, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:8baf7c38-565c-e5bb-3c53-1ff098dfb172", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "8baf7c38-565c-e5bb-3c53-1ff098dfb172", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "4098305a-1858-11f8-c94b-bcdc10593052" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2016-07-31T09:16:25+01:00", + "end": "2017-07-31T09:16:25+01:00" + }, + "created": "2016-07-31T09:16:25+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:4098305a-1858-11f8-c94b-bcdc10593052" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:4487f6cb-dc89-9ac5-f4f4-88f50ed543eb" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + } ] + }, { + "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": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "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://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": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "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://loinc.org", + "code": "58410-2", + "display": "CBC panel - Blood by Automated count" + } ], + "text": "CBC panel - Blood by Automated count" + }, + "servicedPeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 5, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "servicedPeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 6, + "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": "422650009", + "display": "Social isolation (finding)" + } ], + "text": "Social isolation (finding)" + }, + "servicedPeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "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": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "servicedPeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": [ 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": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "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": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 12, + "informationSequence": [ 5 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "82666-9", + "display": "Drug Abuse Screening Test-10 [DAST-10]" + } ], + "text": "Drug Abuse Screening Test-10 [DAST-10]" + }, + "servicedPeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "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": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "servicedPeriod": { + "start": "2016-07-31T08:41:58+01:00", + "end": "2016-07-31T09:16:25+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 853.36, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 2418.176, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:c70a1aca-c5b6-e20a-a072-dd4bf5983a39", + "resource": { + "resourceType": "Encounter", + "id": "c70a1aca-c5b6-e20a-a072-dd4bf5983a39", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:03cbe148-d96a-e73b-991f-25d03acf0873", + "resource": { + "resourceType": "Procedure", + "id": "03cbe148-d96a-e73b-991f-25d03acf0873", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + }, + "performedPeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T09:16:06+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:63400871-9da7-ac42-7b52-76a0405a2265", + "resource": { + "resourceType": "Procedure", + "id": "63400871-9da7-ac42-7b52-76a0405a2265", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + }, + "performedPeriod": { + "start": "2016-08-14T09:16:06+01:00", + "end": "2016-08-14T09:35:38+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:3378397d-3667-cfc3-2230-fd4ab13a2839", + "resource": { + "resourceType": "Procedure", + "id": "3378397d-3667-cfc3-2230-fd4ab13a2839", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + }, + "performedPeriod": { + "start": "2016-08-14T09:35:38+01:00", + "end": "2016-08-14T10:19:20+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:5374f914-2c0a-06fc-aeca-a2f6273cb3e6", + "resource": { + "resourceType": "Procedure", + "id": "5374f914-2c0a-06fc-aeca-a2f6273cb3e6", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + }, + "performedPeriod": { + "start": "2016-08-14T10:19:20+01:00", + "end": "2016-08-14T10:28:05+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:424db386-ada2-db7d-3de5-ab07b1cf3d64", + "resource": { + "resourceType": "Procedure", + "id": "424db386-ada2-db7d-3de5-ab07b1cf3d64", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + }, + "performedPeriod": { + "start": "2016-08-14T10:28:05+01:00", + "end": "2016-08-14T11:19:55+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:84877c3c-96de-bdec-1d28-78c148053cfe", + "resource": { + "resourceType": "Procedure", + "id": "84877c3c-96de-bdec-1d28-78c148053cfe", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + }, + "performedPeriod": { + "start": "2016-08-14T11:19:55+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:270f0e9b-b387-bff2-52c7-b5a944b0cb88", + "resource": { + "resourceType": "SupplyDelivery", + "id": "270f0e9b-b387-bff2-52c7-b5a944b0cb88", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + } + }, + "occurrenceDateTime": "2016-08-14T09:35:38+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:361b431f-fb2d-db98-78e7-4792b8afa75f", + "resource": { + "resourceType": "SupplyDelivery", + "id": "361b431f-fb2d-db98-78e7-4792b8afa75f", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + } + }, + "occurrenceDateTime": "2016-08-14T09:35:38+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:d47cbacd-4ae1-dc89-445b-9abaf4332e6f", + "resource": { + "resourceType": "SupplyDelivery", + "id": "d47cbacd-4ae1-dc89-445b-9abaf4332e6f", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + } + }, + "occurrenceDateTime": "2016-08-14T09:35:38+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:1945504c-59ce-7be7-9d42-b50ae5119622", + "resource": { + "resourceType": "DiagnosticReport", + "id": "1945504c-59ce-7be7-9d42-b50ae5119622", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + }, + "effectiveDateTime": "2016-08-14T08:41:58+01:00", + "issued": "2016-08-14T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "DQoyMDE2LTA4LTE0DQoNCiMgQ2hpZWYgQ29tcGxhaW50DQotIENoZXN0IFByZXNzdXJlDQoNCg0KIyBIaXN0b3J5IG9mIFByZXNlbnQgSWxsbmVzcw0KSGVyYmVydDgzMA0KIGlzIGEgMzYgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIGdpbmdpdmFsIGRpc2Vhc2UgKGRpc29yZGVyKSwgcGFydGlhbCB0aGlja25lc3MgYnVybiAoZGlzb3JkZXIpLCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIHVuaGVhbHRoeSBhbGNvaG9sIGRyaW5raW5nIGJlaGF2aW9yIChmaW5kaW5nKSwgdW5lbXBsb3llZCAoZmluZGluZyksIGFjdXRlIGluZmVjdGl2ZSBjeXN0aXRpcyAoZGlzb3JkZXIpLCBnaW5naXZpdGlzIChkaXNvcmRlciksIHN0cmVzcyAoZmluZGluZyksIGJ1cm4gaW5qdXJ5IChtb3JwaG9sb2dpYyBhYm5vcm1hbGl0eSksIHNvY2lhbCBpc29sYXRpb24gKGZpbmRpbmcpLg0KDQojIFNvY2lhbCBIaXN0b3J5DQpQYXRpZW50IGlzIG1hcnJpZWQuIFBhdGllbnQgcXVpdCBzbW9raW5nIGF0IGFnZSAxNi4NCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLg0KDQpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLg0KIFBhdGllbnQgaGFzIGNvbXBsZXRlZCBzb21lIGNvbGxlZ2UgY291cnNlcy4NClBhdGllbnQgY3VycmVudGx5IGhhcyBBZXRuYS4NCg0KIyBBbGxlcmdpZXMNCk5vIEtub3duIEFsbGVyZ2llcy4NCg0KIyBNZWRpY2F0aW9ucw0KbmRhMDIwOTgzIDIwMCBhY3R1YXQgYWxidXRlcm9sIDAuMDkgbWcvYWN0dWF0IG1ldGVyZWQgZG9zZSBpbmhhbGVyIFt2ZW50b2xpbl07IGFjZXRhbWlub3BoZW4gMzI1IG1nIC8gb3h5Y29kb25lIGh5ZHJvY2hsb3JpZGUgNSBtZyBvcmFsIHRhYmxldDsgY2VmZGluaXI7IG5hcHJveGVuIHNvZGl1bSAyMjAgbWcgb3JhbCB0YWJsZXQ7IGJ1ZGVzb25pZGUgMC4yNSBtZy9tbCBpbmhhbGF0aW9uIHN1c3BlbnNpb247IGNpcHJvZmxveGFjaW4gNTAwIG1nIG9yYWwgdGFibGV0DQoNCiMgQXNzZXNzbWVudCBhbmQgUGxhbg0KDQoNCg0KIyMgUGxhbg0KDQpUaGUgZm9sbG93aW5nIHByb2NlZHVyZXMgd2VyZSBjb25kdWN0ZWQ6DQotIGRlbnRhbCBjb25zdWx0YXRpb24gYW5kIHJlcG9ydCAocHJvY2VkdXJlKQ0KLSBkZW50YWwgY2FyZSAocmVnaW1lL3RoZXJhcHkpDQotIHJlbW92YWwgb2Ygc3VwcmFnaW5naXZhbCBwbGFxdWUgYW5kIGNhbGN1bHVzIGZyb20gYWxsIHRlZXRoIHVzaW5nIGRlbnRhbCBpbnN0cnVtZW50IChwcm9jZWR1cmUpDQotIHJlbW92YWwgb2Ygc3ViZ2luZ2l2YWwgcGxhcXVlIGFuZCBjYWxjdWx1cyBmcm9tIGFsbCB0ZWV0aCB1c2luZyBkZW50YWwgaW5zdHJ1bWVudCAocHJvY2VkdXJlKQ0KLSBleGFtaW5hdGlvbiBvZiBnaW5naXZhZSAocHJvY2VkdXJlKQ0KLSBvcmFsIGhlYWx0aCBlZHVjYXRpb24gKHByb2NlZHVyZSkNCg==" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:de4d853c-d65d-462c-f71f-615cc1833a86", + "resource": { + "resourceType": "DocumentReference", + "id": "de4d853c-d65d-462c-f71f-615cc1833a86", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:1945504c-59ce-7be7-9d42-b50ae5119622" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2016-08-14T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + } ], + "period": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:7a8d9d88-04b2-64f2-a4ef-356b59e9efc2", + "resource": { + "resourceType": "Claim", + "id": "7a8d9d88-04b2-64f2-a4ef-356b59e9efc2", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "created": "2016-08-14T11:48:22+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "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" + } ] + } + }, { + "sequence": 3, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:03cbe148-d96a-e73b-991f-25d03acf0873" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:63400871-9da7-ac42-7b52-76a0405a2265" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:3378397d-3667-cfc3-2230-fd4ab13a2839" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:5374f914-2c0a-06fc-aeca-a2f6273cb3e6" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:424db386-ada2-db7d-3de5-ab07b1cf3d64" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:84877c3c-96de-bdec-1d28-78c148053cfe" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185349003", + "display": "Encounter for check up (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + } ] + }, { + "sequence": 2, + "procedureSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 3, + "procedureSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 4, + "informationSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 5, + "informationSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 6, + "informationSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 7, + "procedureSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 8, + "procedureSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 9, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 10, + "procedureSequence": [ 6 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 2673.95, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:2ae82313-524e-557a-666c-4b4910da5fb4", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "2ae82313-524e-557a-666c-4b4910da5fb4", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "7a8d9d88-04b2-64f2-a4ef-356b59e9efc2" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2016-08-14T11:48:22+01:00", + "end": "2017-08-14T11:48:22+01:00" + }, + "created": "2016-08-14T11:48:22+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:7a8d9d88-04b2-64f2-a4ef-356b59e9efc2" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "servicedPeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + } ] + }, { + "sequence": 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": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "servicedPeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "servicedPeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "servicedPeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "servicedPeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "servicedPeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "servicedPeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "servicedPeriod": { + "start": "2016-08-14T08:41:58+01:00", + "end": "2016-08-14T11:48:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 2673.95, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 2070.72, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:4758fcac-84a9-de7e-a73b-0e68d13ea729", + "resource": { + "resourceType": "Encounter", + "id": "4758fcac-84a9-de7e-a73b-0e68d13ea729", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "4758fcac-84a9-de7e-a73b-0e68d13ea729" + } ], + "status": "finished", + "class": { + "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", + "code": "AMB" + }, + "type": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2017-01-19T11:41:58+01:00", + "end": "2017-01-19T11:56:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2017-01-19T11:41:58+01:00", + "end": "2017-01-19T11:56:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "195967001", + "display": "Asthma (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:611a460c-a446-ad0e-3282-a95414c659a6", + "resource": { + "resourceType": "DiagnosticReport", + "id": "611a460c-a446-ad0e-3282-a95414c659a6", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4758fcac-84a9-de7e-a73b-0e68d13ea729" + }, + "effectiveDateTime": "2017-01-19T11:41:58+01:00", + "issued": "2017-01-19T11:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:c6e3cf74-9f9a-e47a-c448-8dffe2b51ffe", + "resource": { + "resourceType": "DocumentReference", + "id": "c6e3cf74-9f9a-e47a-c448-8dffe2b51ffe", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:611a460c-a446-ad0e-3282-a95414c659a6" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2017-01-19T11:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:4758fcac-84a9-de7e-a73b-0e68d13ea729" + } ], + "period": { + "start": "2017-01-19T11:41:58+01:00", + "end": "2017-01-19T11:56:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:dc33d877-ccbf-9654-2a3d-937b4306b6cb", + "resource": { + "resourceType": "Claim", + "id": "dc33d877-ccbf-9654-2a3d-937b4306b6cb", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2017-01-19T11:41:58+01:00", + "end": "2017-01-19T11:56:58+01:00" + }, + "created": "2017-01-19T11:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "encounter": [ { + "reference": "urn:uuid:4758fcac-84a9-de7e-a73b-0e68d13ea729" + } ] + } ], + "total": { + "value": 142.58, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:2db5d594-6011-1b25-6ad2-f356745edf84", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "2db5d594-6011-1b25-6ad2-f356745edf84", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "dc33d877-ccbf-9654-2a3d-937b4306b6cb" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2017-01-19T11:56:58+01:00", + "end": "2018-01-19T11:56:58+01:00" + }, + "created": "2017-01-19T11:56:58+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:dc33d877-ccbf-9654-2a3d-937b4306b6cb" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "servicedPeriod": { + "start": "2017-01-19T11:41:58+01:00", + "end": "2017-01-19T11:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:4758fcac-84a9-de7e-a73b-0e68d13ea729" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 142.58, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:72ebe461-b488-6aa0-ca78-4e4d9019fe5d", + "resource": { + "resourceType": "Encounter", + "id": "72ebe461-b488-6aa0-ca78-4e4d9019fe5d", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "72ebe461-b488-6aa0-ca78-4e4d9019fe5d" + } ], + "status": "finished", + "class": { + "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", + "code": "EMER" + }, + "type": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "183478001", + "display": "Emergency hospital admission for asthma (procedure)" + } ], + "text": "Emergency hospital admission for asthma (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2017-07-18T11:41:58+01:00", + "end": "2017-07-18T12:41:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } + } ], + "period": { + "start": "2017-07-18T11:41:58+01:00", + "end": "2017-07-18T12:41:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "195967001", + "display": "Asthma (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:034f41b6-777b-3a84-00b4-0041ba957608", + "resource": { + "resourceType": "DiagnosticReport", + "id": "034f41b6-777b-3a84-00b4-0041ba957608", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:72ebe461-b488-6aa0-ca78-4e4d9019fe5d" + }, + "effectiveDateTime": "2017-07-18T11:41:58+01:00", + "issued": "2017-07-18T11:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:305a8773-54f1-1227-0236-a75e7ae56c40", + "resource": { + "resourceType": "DocumentReference", + "id": "305a8773-54f1-1227-0236-a75e7ae56c40", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:034f41b6-777b-3a84-00b4-0041ba957608" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2017-07-18T11:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "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:72ebe461-b488-6aa0-ca78-4e4d9019fe5d" + } ], + "period": { + "start": "2017-07-18T11:41:58+01:00", + "end": "2017-07-18T12:41:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:e8b15c2a-d1b6-fd45-5516-347c21eb3068", + "resource": { + "resourceType": "Claim", + "id": "e8b15c2a-d1b6-fd45-5516-347c21eb3068", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "institutional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2017-07-18T11:41:58+01:00", + "end": "2017-07-18T12:41:58+01:00" + }, + "created": "2017-07-18T12:41:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "183478001", + "display": "Emergency hospital admission for asthma (procedure)" + } ], + "text": "Emergency hospital admission for asthma (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:72ebe461-b488-6aa0-ca78-4e4d9019fe5d" + } ] + } ], + "total": { + "value": 146.18, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:5b053647-433b-f2fd-4542-536505507ab1", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "5b053647-433b-f2fd-4542-536505507ab1", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "e8b15c2a-d1b6-fd45-5516-347c21eb3068" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2017-07-18T12:41:58+01:00", + "end": "2018-07-18T12:41:58+01:00" + }, + "created": "2017-07-18T12:41:58+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "claim": { + "reference": "urn:uuid:e8b15c2a-d1b6-fd45-5516-347c21eb3068" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "183478001", + "display": "Emergency hospital admission for asthma (procedure)" + } ], + "text": "Emergency hospital admission for asthma (procedure)" + }, + "servicedPeriod": { + "start": "2017-07-18T11:41:58+01:00", + "end": "2017-07-18T12:41:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:72ebe461-b488-6aa0-ca78-4e4d9019fe5d" + } ] + } ], + "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:86600c15-53b5-6445-4a56-833dce7ec62b", + "resource": { + "resourceType": "Encounter", + "id": "86600c15-53b5-6445-4a56-833dce7ec62b", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "86600c15-53b5-6445-4a56-833dce7ec62b" + } ], + "status": "finished", + "class": { + "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", + "code": "AMB" + }, + "type": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2017-07-19T23:41:58+01:00", + "end": "2017-07-19T23:56:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2017-07-19T23:41:58+01:00", + "end": "2017-07-19T23:56:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "195967001", + "display": "Asthma (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:5de2420d-bec4-626a-2f4a-a5552f440f02", + "resource": { + "resourceType": "DiagnosticReport", + "id": "5de2420d-bec4-626a-2f4a-a5552f440f02", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:86600c15-53b5-6445-4a56-833dce7ec62b" + }, + "effectiveDateTime": "2017-07-19T23:41:58+01:00", + "issued": "2017-07-19T23:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:ddceaf5a-df7a-d61a-db33-6de62295119e", + "resource": { + "resourceType": "DocumentReference", + "id": "ddceaf5a-df7a-d61a-db33-6de62295119e", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:5de2420d-bec4-626a-2f4a-a5552f440f02" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2017-07-19T23:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:86600c15-53b5-6445-4a56-833dce7ec62b" + } ], + "period": { + "start": "2017-07-19T23:41:58+01:00", + "end": "2017-07-19T23:56:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:87c643d9-7f76-aad6-51cf-e70020ebabbf", + "resource": { + "resourceType": "Claim", + "id": "87c643d9-7f76-aad6-51cf-e70020ebabbf", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2017-07-19T23:41:58+01:00", + "end": "2017-07-19T23:56:58+01:00" + }, + "created": "2017-07-19T23:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "encounter": [ { + "reference": "urn:uuid:86600c15-53b5-6445-4a56-833dce7ec62b" + } ] + } ], + "total": { + "value": 142.58, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:374f1211-df29-e17e-ef91-a317cf858521", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "374f1211-df29-e17e-ef91-a317cf858521", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "87c643d9-7f76-aad6-51cf-e70020ebabbf" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2017-07-19T23:56:58+01:00", + "end": "2018-07-19T23:56:58+01:00" + }, + "created": "2017-07-19T23:56:58+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:87c643d9-7f76-aad6-51cf-e70020ebabbf" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "servicedPeriod": { + "start": "2017-07-19T23:41:58+01:00", + "end": "2017-07-19T23:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:86600c15-53b5-6445-4a56-833dce7ec62b" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 142.58, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc", + "resource": { + "resourceType": "Encounter", + "id": "0ffa33af-69f3-ddc9-12e4-599d515fe6cc", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:9b56227c-7f69-6fd8-bc0c-db87a91a5b85", + "resource": { + "resourceType": "Condition", + "id": "9b56227c-7f69-6fd8-bc0c-db87a91a5b85", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "onsetDateTime": "2017-08-06T09:31:57+01:00", + "abatementDateTime": "2019-08-18T09:38:26+01:00", + "recordedDate": "2017-08-06T09:31:57+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:f09092f2-0b0b-3ffc-9e53-98256035ed2e", + "resource": { + "resourceType": "Observation", + "id": "f09092f2-0b0b-3ffc-9e53-98256035ed2e", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T08:41:58+01:00", + "issued": "2017-08-06T08:41:58.201+01:00", + "valueQuantity": { + "value": 168.8, + "unit": "cm", + "system": "http://unitsofmeasure.org", + "code": "cm" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:21b2512a-a9b8-e831-f7f2-a3d2bcd90c07", + "resource": { + "resourceType": "Observation", + "id": "21b2512a-a9b8-e831-f7f2-a3d2bcd90c07", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T08:41:58+01:00", + "issued": "2017-08-06T08:41:58.201+01:00", + "valueQuantity": { + "value": 2, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:9755901c-1752-314e-00e4-a8e33cd34461", + "resource": { + "resourceType": "Observation", + "id": "9755901c-1752-314e-00e4-a8e33cd34461", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T08:41:58+01:00", + "issued": "2017-08-06T08:41:58.201+01:00", + "valueQuantity": { + "value": 86.8, + "unit": "kg", + "system": "http://unitsofmeasure.org", + "code": "kg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:f4333f56-6d5b-7086-85f8-6c59b9106dd5", + "resource": { + "resourceType": "Observation", + "id": "f4333f56-6d5b-7086-85f8-6c59b9106dd5", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T08:41:58+01:00", + "issued": "2017-08-06T08:41:58.201+01:00", + "valueQuantity": { + "value": 30.46, + "unit": "kg/m2", + "system": "http://unitsofmeasure.org", + "code": "kg/m2" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:1b6c052c-51f8-0ae9-4b1f-cd29ee80a179", + "resource": { + "resourceType": "Observation", + "id": "1b6c052c-51f8-0ae9-4b1f-cd29ee80a179", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T08:41:58+01:00", + "issued": "2017-08-06T08:41:58.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "8462-4", + "display": "Diastolic Blood Pressure" + } ], + "text": "Diastolic Blood Pressure" + }, + "valueQuantity": { + "value": 95, + "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": 104, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:a6f98e00-1aa1-c10b-bb09-8cd54b2300a9", + "resource": { + "resourceType": "Observation", + "id": "a6f98e00-1aa1-c10b-bb09-8cd54b2300a9", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T08:41:58+01:00", + "issued": "2017-08-06T08:41:58.201+01:00", + "valueQuantity": { + "value": 92, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:e6f53589-e315-e5a6-f90f-cf69c4af726b", + "resource": { + "resourceType": "Observation", + "id": "e6f53589-e315-e5a6-f90f-cf69c4af726b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T08:41:58+01:00", + "issued": "2017-08-06T08:41:58.201+01:00", + "valueQuantity": { + "value": 13, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:0474fc56-8677-4fa1-2f94-e32f88698dac", + "resource": { + "resourceType": "Observation", + "id": "0474fc56-8677-4fa1-2f94-e32f88698dac", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T08:41:58+01:00", + "issued": "2017-08-06T08:41:58.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "8517006", + "display": "Ex-smoker (finding)" + } ], + "text": "Ex-smoker (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:b85806f2-eed1-78e7-afd3-fd83d3f68c5f", + "resource": { + "resourceType": "Observation", + "id": "b85806f2-eed1-78e7-afd3-fd83d3f68c5f", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T09:31:57+01:00", + "issued": "2017-08-06T09:31:57.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "76501-6", + "display": "Within the last year, have you been afraid of your partner or ex-partner?" + } ], + "text": "Within the last year, have you been afraid of your partner or ex-partner?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93026-3", + "display": "Do you feel physically and emotionally safe where you currently live?" + } ], + "text": "Do you feel physically and emotionally safe where you currently live?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA33-6", + "display": "Yes" + } ], + "text": "Yes" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93027-1", + "display": "Are you a refugee?" + } ], + "text": "Are you a refugee?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93028-9", + "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + } ], + "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93038-8", + "display": "Stress level" + } ], + "text": "Stress level" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA6568-5", + "display": "Not at all" + } ], + "text": "Not at all" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93029-7", + "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + } ], + "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30132-7", + "display": "5 or more times a week" + } ], + "text": "5 or more times a week" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93030-5", + "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + } ], + "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93031-3", + "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + } ], + "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30125-1", + "display": "Food" + } ], + "text": "Food" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63586-2", + "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + } ], + "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + }, + "valueQuantity": { + "value": 60262, + "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": "627 Ullrich Dam Unit 88" + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93033-9", + "display": "Are you worried about losing your housing?" + } ], + "text": "Are you worried about losing your housing?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "71802-3", + "display": "Housing status" + } ], + "text": "Housing status" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30189-7", + "display": "I have housing" + } ], + "text": "I have housing" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63512-8", + "display": "How many people are living or staying at this address?" + } ], + "text": "How many people are living or staying at this address?" + }, + "valueQuantity": { + "value": 7, + "unit": "{#}", + "system": "http://unitsofmeasure.org", + "code": "{#}" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "54899-0", + "display": "Preferred language" + } ], + "text": "Preferred language" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA43-5", + "display": "English" + } ], + "text": "English" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93034-7", + "display": "Have you been discharged from the armed forces of the United States?" + } ], + "text": "Have you been discharged from the armed forces of the United States?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93035-4", + "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + } ], + "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "32624-9", + "display": "Race" + } ], + "text": "Race" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA4457-3", + "display": "White" + } ], + "text": "White" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "56051-6", + "display": "Do you consider yourself Hispanic/Latino?" + } ], + "text": "Do you consider yourself Hispanic/Latino?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:b88c5d40-5348-701b-a502-030f3a85c54d", + "resource": { + "resourceType": "Observation", + "id": "b88c5d40-5348-701b-a502-030f3a85c54d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T10:04:13+01:00", + "issued": "2017-08-06T10:04:13.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c72dd41b-2751-4699-2076-870405d92866", + "resource": { + "resourceType": "Observation", + "id": "c72dd41b-2751-4699-2076-870405d92866", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T10:38:18+01:00", + "issued": "2017-08-06T10:38:18.201+01:00", + "valueQuantity": { + "value": 2, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:f4559626-b9a9-71b6-b921-78f533062822", + "resource": { + "resourceType": "Procedure", + "id": "f4559626-b9a9-71b6-b921-78f533062822", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "performedPeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:0f5c8424-46a6-97d2-3463-85be1181976e", + "resource": { + "resourceType": "Procedure", + "id": "0f5c8424-46a6-97d2-3463-85be1181976e", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "performedPeriod": { + "start": "2017-08-06T09:31:57+01:00", + "end": "2017-08-06T09:42:19+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:13d5657c-ab0a-81e7-4cbe-e86e289663c6", + "resource": { + "resourceType": "Procedure", + "id": "13d5657c-ab0a-81e7-4cbe-e86e289663c6", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "performedPeriod": { + "start": "2017-08-06T09:42:19+01:00", + "end": "2017-08-06T10:04:13+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:9efbb839-4ffb-06f2-0418-9c383fa02e79", + "resource": { + "resourceType": "Procedure", + "id": "9efbb839-4ffb-06f2-0418-9c383fa02e79", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "performedPeriod": { + "start": "2017-08-06T10:04:13+01:00", + "end": "2017-08-06T10:16:57+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:7db29bf8-c95d-6026-8f27-18bebf846255", + "resource": { + "resourceType": "Procedure", + "id": "7db29bf8-c95d-6026-8f27-18bebf846255", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "performedPeriod": { + "start": "2017-08-06T10:16:57+01:00", + "end": "2017-08-06T10:38:18+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:47472be1-4df0-48de-52a3-3acc3a53523b", + "resource": { + "resourceType": "MedicationRequest", + "id": "47472be1-4df0-48de-52a3-3acc3a53523b", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "authoredOn": "2017-08-06T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:2f0dfe6a-9d63-652d-4811-3988c421e13a", + "resource": { + "resourceType": "Claim", + "id": "2f0dfe6a-9d63-652d-4811-3988c421e13a", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "created": "2017-08-06T09:31:57+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:47472be1-4df0-48de-52a3-3acc3a53523b" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "encounter": [ { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:03332088-43cf-bb54-0d7a-041da65e4a35", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "03332088-43cf-bb54-0d7a-041da65e4a35", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "2f0dfe6a-9d63-652d-4811-3988c421e13a" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2017-08-06T09:31:57+01:00", + "end": "2018-08-06T09:31:57+01:00" + }, + "created": "2017-08-06T09:31:57+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:2f0dfe6a-9d63-652d-4811-3988c421e13a" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "servicedPeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:acb0bdd6-2cce-554e-88c6-c16f7317447c", + "resource": { + "resourceType": "MedicationRequest", + "id": "acb0bdd6-2cce-554e-88c6-c16f7317447c", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "authoredOn": "2017-08-06T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:0256a7e2-aab6-6475-d2d7-3b381ec2d93d", + "resource": { + "resourceType": "Claim", + "id": "0256a7e2-aab6-6475-d2d7-3b381ec2d93d", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "created": "2017-08-06T09:31:57+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:acb0bdd6-2cce-554e-88c6-c16f7317447c" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "encounter": [ { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:97671859-6938-eb58-abdb-8f61bb700803", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "97671859-6938-eb58-abdb-8f61bb700803", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "0256a7e2-aab6-6475-d2d7-3b381ec2d93d" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2017-08-06T09:31:57+01:00", + "end": "2018-08-06T09:31:57+01:00" + }, + "created": "2017-08-06T09:31:57+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:0256a7e2-aab6-6475-d2d7-3b381ec2d93d" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "servicedPeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:f469fdef-5386-02ed-5224-ae688b3a394c", + "resource": { + "resourceType": "Immunization", + "id": "f469fdef-5386-02ed-5224-ae688b3a394c", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "occurrenceDateTime": "2017-08-06T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:816773ac-f8c6-19d1-11f2-c96d0931339c", + "resource": { + "resourceType": "DiagnosticReport", + "id": "816773ac-f8c6-19d1-11f2-c96d0931339c", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T10:04:13+01:00", + "issued": "2017-08-06T10:04:13.201+01:00", + "result": [ { + "reference": "urn:uuid:b88c5d40-5348-701b-a502-030f3a85c54d", + "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:c8ecde36-9db4-6997-7e8b-bb4e6237a8f5", + "resource": { + "resourceType": "DiagnosticReport", + "id": "c8ecde36-9db4-6997-7e8b-bb4e6237a8f5", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T10:38:18+01:00", + "issued": "2017-08-06T10:38:18.201+01:00", + "result": [ { + "reference": "urn:uuid:c72dd41b-2751-4699-2076-870405d92866", + "display": "Total score [AUDIT-C]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:56526c47-8f7a-f1a9-53b7-2ad2d2952d2d", + "resource": { + "resourceType": "DiagnosticReport", + "id": "56526c47-8f7a-f1a9-53b7-2ad2d2952d2d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, + "effectiveDateTime": "2017-08-06T08:41:58+01:00", + "issued": "2017-08-06T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:2ed37c3e-6e45-9ae6-00af-9c299439f4ff", + "resource": { + "resourceType": "DocumentReference", + "id": "2ed37c3e-6e45-9ae6-00af-9c299439f4ff", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:56526c47-8f7a-f1a9-53b7-2ad2d2952d2d" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2017-08-06T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + } ], + "period": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:30312e31-7211-6dda-eb95-086c076b70da", + "resource": { + "resourceType": "Claim", + "id": "30312e31-7211-6dda-eb95-086c076b70da", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "created": "2017-08-06T09:31:57+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:f469fdef-5386-02ed-5224-ae688b3a394c" + } + }, { + "sequence": 2, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + }, { + "sequence": 3, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:9b56227c-7f69-6fd8-bc0c-db87a91a5b85" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:f4559626-b9a9-71b6-b921-78f533062822" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:0f5c8424-46a6-97d2-3463-85be1181976e" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:13d5657c-ab0a-81e7-4cbe-e86e289663c6" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:9efbb839-4ffb-06f2-0418-9c383fa02e79" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:7db29bf8-c95d-6026-8f27-18bebf846255" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "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:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + } ] + }, { + "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": "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": 4, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "160903007", + "display": "Full-time employment (finding)" + } ], + "text": "Full-time employment (finding)" + } + }, { + "sequence": 5, + "procedureSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 6, + "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": 7, + "informationSequence": [ 2 ], + "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": 8, + "procedureSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "428211000124100", + "display": "Assessment of substance use (procedure)" + } ], + "text": "Assessment of substance use (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 9, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "763302001", + "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" + } ], + "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 10, + "informationSequence": [ 3 ], + "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": 704.20, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:bb729c7a-0673-677a-10fc-d6b58a9c8309", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "bb729c7a-0673-677a-10fc-d6b58a9c8309", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "30312e31-7211-6dda-eb95-086c076b70da" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2017-08-06T09:31:57+01:00", + "end": "2018-08-06T09:31:57+01:00" + }, + "created": "2017-08-06T09:31:57+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:30312e31-7211-6dda-eb95-086c076b70da" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:9b56227c-7f69-6fd8-bc0c-db87a91a5b85" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + } ] + }, { + "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": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "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": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "servicedPeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": 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": "160903007", + "display": "Full-time employment (finding)" + } ], + "text": "Full-time employment (finding)" + }, + "servicedPeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "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": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "servicedPeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 6, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "servicedPeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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, + "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": "55757-9", + "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" + } ], + "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" + }, + "servicedPeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 8, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "428211000124100", + "display": "Assessment of substance use (procedure)" + } ], + "text": "Assessment of substance use (procedure)" + }, + "servicedPeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 9, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "763302001", + "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" + } ], + "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" + }, + "servicedPeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": [ 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": "72109-2", + "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" + } ], + "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" + }, + "servicedPeriod": { + "start": "2017-08-06T08:41:58+01:00", + "end": "2017-08-06T09:31:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 704.20, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 1953.7279999999998, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323", + "resource": { + "resourceType": "Encounter", + "id": "3f4a08f5-6764-8944-c960-b65b4def1323", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "3f4a08f5-6764-8944-c960-b65b4def1323" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:b5b1a2d0-3683-4c46-203e-51553a4d4b4c", + "resource": { + "resourceType": "Observation", + "id": "b5b1a2d0-3683-4c46-203e-51553a4d4b4c", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T08:41:58+01:00", + "issued": "2018-08-12T08:41:58.201+01:00", + "valueQuantity": { + "value": 168.8, + "unit": "cm", + "system": "http://unitsofmeasure.org", + "code": "cm" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:7030faa8-1b89-b38e-20da-6578ca0b0f00", + "resource": { + "resourceType": "Observation", + "id": "7030faa8-1b89-b38e-20da-6578ca0b0f00", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T08:41:58+01:00", + "issued": "2018-08-12T08:41:58.201+01:00", + "valueQuantity": { + "value": 3, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:949083fe-1915-c5a6-d7f4-8532c2657ede", + "resource": { + "resourceType": "Observation", + "id": "949083fe-1915-c5a6-d7f4-8532c2657ede", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T08:41:58+01:00", + "issued": "2018-08-12T08:41:58.201+01:00", + "valueQuantity": { + "value": 86.8, + "unit": "kg", + "system": "http://unitsofmeasure.org", + "code": "kg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:d38f3ec5-00c4-7cf6-7e87-45614709740b", + "resource": { + "resourceType": "Observation", + "id": "d38f3ec5-00c4-7cf6-7e87-45614709740b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T08:41:58+01:00", + "issued": "2018-08-12T08:41:58.201+01:00", + "valueQuantity": { + "value": 30.46, + "unit": "kg/m2", + "system": "http://unitsofmeasure.org", + "code": "kg/m2" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:74c7a353-de01-4f89-2578-04b489af20c0", + "resource": { + "resourceType": "Observation", + "id": "74c7a353-de01-4f89-2578-04b489af20c0", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T08:41:58+01:00", + "issued": "2018-08-12T08:41:58.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "8462-4", + "display": "Diastolic Blood Pressure" + } ], + "text": "Diastolic Blood Pressure" + }, + "valueQuantity": { + "value": 88, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "8480-6", + "display": "Systolic Blood Pressure" + } ], + "text": "Systolic Blood Pressure" + }, + "valueQuantity": { + "value": 105, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:2375721f-7d23-b9e0-5ae0-c10707894dc2", + "resource": { + "resourceType": "Observation", + "id": "2375721f-7d23-b9e0-5ae0-c10707894dc2", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T08:41:58+01:00", + "issued": "2018-08-12T08:41:58.201+01:00", + "valueQuantity": { + "value": 76, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:a679555e-095b-0c9c-1355-12c24c4c51f0", + "resource": { + "resourceType": "Observation", + "id": "a679555e-095b-0c9c-1355-12c24c4c51f0", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T08:41:58+01:00", + "issued": "2018-08-12T08:41:58.201+01:00", + "valueQuantity": { + "value": 15, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:d9762962-7ed2-a160-1227-591a5d40cb46", + "resource": { + "resourceType": "Observation", + "id": "d9762962-7ed2-a160-1227-591a5d40cb46", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T08:41:58+01:00", + "issued": "2018-08-12T08:41:58.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "8517006", + "display": "Ex-smoker (finding)" + } ], + "text": "Ex-smoker (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:64d4ac33-3c0b-e627-e505-febf69b2caaf", + "resource": { + "resourceType": "Observation", + "id": "64d4ac33-3c0b-e627-e505-febf69b2caaf", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T09:18:53+01:00", + "issued": "2018-08-12T09:18:53.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "76501-6", + "display": "Within the last year, have you been afraid of your partner or ex-partner?" + } ], + "text": "Within the last year, have you been afraid of your partner or ex-partner?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93026-3", + "display": "Do you feel physically and emotionally safe where you currently live?" + } ], + "text": "Do you feel physically and emotionally safe where you currently live?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA33-6", + "display": "Yes" + } ], + "text": "Yes" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93027-1", + "display": "Are you a refugee?" + } ], + "text": "Are you a refugee?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93028-9", + "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + } ], + "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93038-8", + "display": "Stress level" + } ], + "text": "Stress level" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA6568-5", + "display": "Not at all" + } ], + "text": "Not at all" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93029-7", + "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + } ], + "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30131-9", + "display": "3 to 5 times a week" + } ], + "text": "3 to 5 times a week" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93030-5", + "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + } ], + "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93031-3", + "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + } ], + "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30125-1", + "display": "Food" + } ], + "text": "Food" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63586-2", + "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + } ], + "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + }, + "valueQuantity": { + "value": 60262, + "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": "627 Ullrich Dam Unit 88" + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93033-9", + "display": "Are you worried about losing your housing?" + } ], + "text": "Are you worried about losing your housing?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "71802-3", + "display": "Housing status" + } ], + "text": "Housing status" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30189-7", + "display": "I have housing" + } ], + "text": "I have housing" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63512-8", + "display": "How many people are living or staying at this address?" + } ], + "text": "How many people are living or staying at this address?" + }, + "valueQuantity": { + "value": 7, + "unit": "{#}", + "system": "http://unitsofmeasure.org", + "code": "{#}" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "54899-0", + "display": "Preferred language" + } ], + "text": "Preferred language" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA43-5", + "display": "English" + } ], + "text": "English" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93034-7", + "display": "Have you been discharged from the armed forces of the United States?" + } ], + "text": "Have you been discharged from the armed forces of the United States?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93035-4", + "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + } ], + "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "32624-9", + "display": "Race" + } ], + "text": "Race" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA4457-3", + "display": "White" + } ], + "text": "White" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "56051-6", + "display": "Do you consider yourself Hispanic/Latino?" + } ], + "text": "Do you consider yourself Hispanic/Latino?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:5b067713-153a-7115-bb41-99252a821cf3", + "resource": { + "resourceType": "Observation", + "id": "5b067713-153a-7115-bb41-99252a821cf3", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T09:54:14+01:00", + "issued": "2018-08-12T09:54:14.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:783ea612-2132-b17e-ab33-7b9a17acfd94", + "resource": { + "resourceType": "Procedure", + "id": "783ea612-2132-b17e-ab33-7b9a17acfd94", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "performedPeriod": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:e7d28c3d-637e-892c-a77b-b82c4ac34b4f", + "resource": { + "resourceType": "Procedure", + "id": "e7d28c3d-637e-892c-a77b-b82c4ac34b4f", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "performedPeriod": { + "start": "2018-08-12T09:18:53+01:00", + "end": "2018-08-12T09:31:01+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:71535973-8924-b97c-b03d-458812a6a9aa", + "resource": { + "resourceType": "Procedure", + "id": "71535973-8924-b97c-b03d-458812a6a9aa", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "performedPeriod": { + "start": "2018-08-12T09:31:01+01:00", + "end": "2018-08-12T09:54:14+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:0974acc8-0aa8-2917-e0d3-070306e8c9bf", + "resource": { + "resourceType": "MedicationRequest", + "id": "0974acc8-0aa8-2917-e0d3-070306e8c9bf", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "authoredOn": "2018-08-12T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:58c3192a-a4e1-353a-63bf-f86ac86702d4", + "resource": { + "resourceType": "Claim", + "id": "58c3192a-a4e1-353a-63bf-f86ac86702d4", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "created": "2018-08-12T09:18:53+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:0974acc8-0aa8-2917-e0d3-070306e8c9bf" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "encounter": [ { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:cfe4901c-72be-79bf-1fe7-26ab53c8fc58", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "cfe4901c-72be-79bf-1fe7-26ab53c8fc58", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "58c3192a-a4e1-353a-63bf-f86ac86702d4" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2018-08-12T09:18:53+01:00", + "end": "2019-08-12T09:18:53+01:00" + }, + "created": "2018-08-12T09:18:53+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:58c3192a-a4e1-353a-63bf-f86ac86702d4" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "servicedPeriod": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:f9d29ace-432e-381f-914d-94e4f24e2fb6", + "resource": { + "resourceType": "MedicationRequest", + "id": "f9d29ace-432e-381f-914d-94e4f24e2fb6", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "authoredOn": "2018-08-12T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:14823687-f224-0d5d-e654-cc753b79a5a7", + "resource": { + "resourceType": "Claim", + "id": "14823687-f224-0d5d-e654-cc753b79a5a7", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "created": "2018-08-12T09:18:53+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:f9d29ace-432e-381f-914d-94e4f24e2fb6" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "encounter": [ { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:c87ca188-79f4-39d4-dc7d-452c3236da7a", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "c87ca188-79f4-39d4-dc7d-452c3236da7a", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "14823687-f224-0d5d-e654-cc753b79a5a7" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2018-08-12T09:18:53+01:00", + "end": "2019-08-12T09:18:53+01:00" + }, + "created": "2018-08-12T09:18:53+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:14823687-f224-0d5d-e654-cc753b79a5a7" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "servicedPeriod": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:9dcc68bc-283e-e159-66dd-258fa4bb02c8", + "resource": { + "resourceType": "Immunization", + "id": "9dcc68bc-283e-e159-66dd-258fa4bb02c8", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "occurrenceDateTime": "2018-08-12T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:5e9385e5-478c-044b-d154-d3c683e4f7c1", + "resource": { + "resourceType": "DiagnosticReport", + "id": "5e9385e5-478c-044b-d154-d3c683e4f7c1", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T09:54:14+01:00", + "issued": "2018-08-12T09:54:14.201+01:00", + "result": [ { + "reference": "urn:uuid:5b067713-153a-7115-bb41-99252a821cf3", + "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:86359947-8d36-67a3-e97d-09c739ce390b", + "resource": { + "resourceType": "DiagnosticReport", + "id": "86359947-8d36-67a3-e97d-09c739ce390b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, + "effectiveDateTime": "2018-08-12T08:41:58+01:00", + "issued": "2018-08-12T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "DQoyMDE4LTA4LTEyDQoNCiMgQ2hpZWYgQ29tcGxhaW50DQotIENoZXN0IFByZXNzdXJlDQoNCg0KIyBIaXN0b3J5IG9mIFByZXNlbnQgSWxsbmVzcw0KSGVyYmVydDgzMA0KIGlzIGEgMzggeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIGdpbmdpdmFsIGRpc2Vhc2UgKGRpc29yZGVyKSwgcGFydGlhbCB0aGlja25lc3MgYnVybiAoZGlzb3JkZXIpLCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIHVuaGVhbHRoeSBhbGNvaG9sIGRyaW5raW5nIGJlaGF2aW9yIChmaW5kaW5nKSwgdW5lbXBsb3llZCAoZmluZGluZyksIGZ1bGwtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgYWN1dGUgaW5mZWN0aXZlIGN5c3RpdGlzIChkaXNvcmRlciksIGdpbmdpdml0aXMgKGRpc29yZGVyKSwgc3RyZXNzIChmaW5kaW5nKSwgYnVybiBpbmp1cnkgKG1vcnBob2xvZ2ljIGFibm9ybWFsaXR5KSwgc29jaWFsIGlzb2xhdGlvbiAoZmluZGluZykuDQoNCiMgU29jaWFsIEhpc3RvcnkNClBhdGllbnQgaXMgbWFycmllZC4gUGF0aWVudCBxdWl0IHNtb2tpbmcgYXQgYWdlIDE2Lg0KIFBhdGllbnQgaWRlbnRpZmllcyBhcyBoZXRlcm9zZXh1YWwuDQoNClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuDQogUGF0aWVudCBoYXMgY29tcGxldGVkIHNvbWUgY29sbGVnZSBjb3Vyc2VzLg0KUGF0aWVudCBjdXJyZW50bHkgaGFzIEFldG5hLg0KDQojIEFsbGVyZ2llcw0KTm8gS25vd24gQWxsZXJnaWVzLg0KDQojIE1lZGljYXRpb25zDQpuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXTsgYWNldGFtaW5vcGhlbiAzMjUgbWcgLyBveHljb2RvbmUgaHlkcm9jaGxvcmlkZSA1IG1nIG9yYWwgdGFibGV0OyBjZWZkaW5pcjsgbmFwcm94ZW4gc29kaXVtIDIyMCBtZyBvcmFsIHRhYmxldDsgYnVkZXNvbmlkZSAwLjI1IG1nL21sIGluaGFsYXRpb24gc3VzcGVuc2lvbjsgY2lwcm9mbG94YWNpbiA1MDAgbWcgb3JhbCB0YWJsZXQNCg0KIyBBc3Nlc3NtZW50IGFuZCBQbGFuDQoNCg0KDQojIyBQbGFuDQpQYXRpZW50IHdhcyBnaXZlbiB0aGUgZm9sbG93aW5nIGltbXVuaXphdGlvbnM6IGluZmx1ZW56YSwgc2Vhc29uYWwsIGluamVjdGFibGUsIHByZXNlcnZhdGl2ZSBmcmVlLiANClRoZSBmb2xsb3dpbmcgcHJvY2VkdXJlcyB3ZXJlIGNvbmR1Y3RlZDoNCi0gYXNzZXNzbWVudCBvZiBoZWFsdGggYW5kIHNvY2lhbCBjYXJlIG5lZWRzIChwcm9jZWR1cmUpDQotIGRlcHJlc3Npb24gc2NyZWVuaW5nIChwcm9jZWR1cmUpDQotIGRlcHJlc3Npb24gc2NyZWVuaW5nIChwcm9jZWR1cmUpDQpUaGUgcGF0aWVudCB3YXMgcHJlc2NyaWJlZCB0aGUgZm9sbG93aW5nIG1lZGljYXRpb25zOg0KLSBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQ0KLSBidWRlc29uaWRlIDAuMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uDQo=" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:0fa8e99a-952d-d0e5-ce34-2cb4d0b1ce49", + "resource": { + "resourceType": "DocumentReference", + "id": "0fa8e99a-952d-d0e5-ce34-2cb4d0b1ce49", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:86359947-8d36-67a3-e97d-09c739ce390b" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2018-08-12T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:3f4a08f5-6764-8944-c960-b65b4def1323" + } ], + "period": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:1f7d893e-c6c4-596e-ae8d-2305f4f837a7", + "resource": { + "resourceType": "Claim", + "id": "1f7d893e-c6c4-596e-ae8d-2305f4f837a7", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "created": "2018-08-12T09:18:53+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:9dcc68bc-283e-e159-66dd-258fa4bb02c8" + } + }, { + "sequence": 2, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:783ea612-2132-b17e-ab33-7b9a17acfd94" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:e7d28c3d-637e-892c-a77b-b82c4ac34b4f" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:71535973-8924-b97c-b03d-458812a6a9aa" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Aetna" + } + } ], + "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:3f4a08f5-6764-8944-c960-b65b4def1323" + } ] + }, { + "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": "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": 4, + "procedureSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 5, + "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": 6, + "informationSequence": [ 2 ], + "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": 704.20, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:2fbb2c4a-863e-8f66-0197-4d9ad9488fb8", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "2fbb2c4a-863e-8f66-0197-4d9ad9488fb8", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Aetna" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Aetna" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "1f7d893e-c6c4-596e-ae8d-2305f4f837a7" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2018-08-12T09:18:53+01:00", + "end": "2019-08-12T09:18:53+01:00" + }, + "created": "2018-08-12T09:18:53+01:00", + "insurer": { + "display": "Aetna" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:1f7d893e-c6c4-596e-ae8d-2305f4f837a7" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Aetna" + } + } ], + "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": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + } ] + }, { + "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": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "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": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "servicedPeriod": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": 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": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "servicedPeriod": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 5, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "servicedPeriod": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 6, + "informationSequence": [ 2 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "55757-9", + "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" + } ], + "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" + }, + "servicedPeriod": { + "start": "2018-08-12T08:41:58+01:00", + "end": "2018-08-12T09:18:53+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 704.20, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 1203.8239999999998, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894", + "resource": { + "resourceType": "Encounter", + "id": "06613751-4755-cb2a-9f34-21ca6b387894", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "06613751-4755-cb2a-9f34-21ca6b387894" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:345d87a1-78fc-4fe1-6f3d-56dd1f539370", + "resource": { + "resourceType": "Condition", + "id": "345d87a1-78fc-4fe1-6f3d-56dd1f539370", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "onsetDateTime": "2019-08-18T09:38:26+01:00", + "abatementDateTime": "2021-08-29T09:21:36+01:00", + "recordedDate": "2019-08-18T09:38:26+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:d78955fb-cd7f-d17b-2f97-595ac8c30d33", + "resource": { + "resourceType": "Condition", + "id": "d78955fb-cd7f-d17b-2f97-595ac8c30d33", + "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": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "onsetDateTime": "2019-08-18T11:28:49+01:00", + "abatementDateTime": "2019-09-01T15:22:33+01:00", + "recordedDate": "2019-08-18T11:28:49+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:af46e0ef-f26d-2247-6e94-ee72144b9234", + "resource": { + "resourceType": "Observation", + "id": "af46e0ef-f26d-2247-6e94-ee72144b9234", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "valueQuantity": { + "value": 168.8, + "unit": "cm", + "system": "http://unitsofmeasure.org", + "code": "cm" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c9ee53df-9c23-b554-9c48-f9fd625e531a", + "resource": { + "resourceType": "Observation", + "id": "c9ee53df-9c23-b554-9c48-f9fd625e531a", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:e778b4f1-7a5d-234c-4771-5ec51f638792", + "resource": { + "resourceType": "Observation", + "id": "e778b4f1-7a5d-234c-4771-5ec51f638792", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "valueQuantity": { + "value": 86.8, + "unit": "kg", + "system": "http://unitsofmeasure.org", + "code": "kg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c30ba9bc-ca8e-6eb7-1148-c3ddf3544f20", + "resource": { + "resourceType": "Observation", + "id": "c30ba9bc-ca8e-6eb7-1148-c3ddf3544f20", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "valueQuantity": { + "value": 30.46, + "unit": "kg/m2", + "system": "http://unitsofmeasure.org", + "code": "kg/m2" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:18b10999-4e4c-152e-1d74-3cd972007646", + "resource": { + "resourceType": "Observation", + "id": "18b10999-4e4c-152e-1d74-3cd972007646", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "8462-4", + "display": "Diastolic Blood Pressure" + } ], + "text": "Diastolic Blood Pressure" + }, + "valueQuantity": { + "value": 92, + "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:42ba6694-d549-6aff-09ea-8f98b4e49116", + "resource": { + "resourceType": "Observation", + "id": "42ba6694-d549-6aff-09ea-8f98b4e49116", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "valueQuantity": { + "value": 79, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c0fbce38-6b16-e4eb-06a9-885b58a23f59", + "resource": { + "resourceType": "Observation", + "id": "c0fbce38-6b16-e4eb-06a9-885b58a23f59", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "valueQuantity": { + "value": 16, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:30349553-3bcf-5955-2a08-e578019d47c7", + "resource": { + "resourceType": "Observation", + "id": "30349553-3bcf-5955-2a08-e578019d47c7", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "valueQuantity": { + "value": 180.58, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c3d76a0e-5a7d-ec80-0941-351db155bec9", + "resource": { + "resourceType": "Observation", + "id": "c3d76a0e-5a7d-ec80-0941-351db155bec9", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "valueQuantity": { + "value": 145.85, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:dca1f527-5066-a553-efad-96cc1432e49c", + "resource": { + "resourceType": "Observation", + "id": "dca1f527-5066-a553-efad-96cc1432e49c", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "valueQuantity": { + "value": 102.97, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:6b8486f4-56cc-b005-2e13-d9f085ef8921", + "resource": { + "resourceType": "Observation", + "id": "6b8486f4-56cc-b005-2e13-d9f085ef8921", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "valueQuantity": { + "value": 48.44, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:5299edd3-ab61-ad7a-02be-f9b18a9967b4", + "resource": { + "resourceType": "Observation", + "id": "5299edd3-ab61-ad7a-02be-f9b18a9967b4", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "8517006", + "display": "Ex-smoker (finding)" + } ], + "text": "Ex-smoker (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:4d1d7469-0b2b-f4fe-83ba-9f7abb7b15c4", + "resource": { + "resourceType": "Observation", + "id": "4d1d7469-0b2b-f4fe-83ba-9f7abb7b15c4", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T09:38:26+01:00", + "issued": "2019-08-18T09:38:26.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "76501-6", + "display": "Within the last year, have you been afraid of your partner or ex-partner?" + } ], + "text": "Within the last year, have you been afraid of your partner or ex-partner?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93026-3", + "display": "Do you feel physically and emotionally safe where you currently live?" + } ], + "text": "Do you feel physically and emotionally safe where you currently live?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA33-6", + "display": "Yes" + } ], + "text": "Yes" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93027-1", + "display": "Are you a refugee?" + } ], + "text": "Are you a refugee?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "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": "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": "LA30125-1", + "display": "Food" + } ], + "text": "Food" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63586-2", + "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + } ], + "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + }, + "valueQuantity": { + "value": 60262, + "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": "627 Ullrich Dam Unit 88" + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93033-9", + "display": "Are you worried about losing your housing?" + } ], + "text": "Are you worried about losing your housing?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "71802-3", + "display": "Housing status" + } ], + "text": "Housing status" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30189-7", + "display": "I have housing" + } ], + "text": "I have housing" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63512-8", + "display": "How many people are living or staying at this address?" + } ], + "text": "How many people are living or staying at this address?" + }, + "valueQuantity": { + "value": 7, + "unit": "{#}", + "system": "http://unitsofmeasure.org", + "code": "{#}" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "54899-0", + "display": "Preferred language" + } ], + "text": "Preferred language" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA43-5", + "display": "English" + } ], + "text": "English" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93034-7", + "display": "Have you been discharged from the armed forces of the United States?" + } ], + "text": "Have you been discharged from the armed forces of the United States?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93035-4", + "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + } ], + "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "32624-9", + "display": "Race" + } ], + "text": "Race" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA4457-3", + "display": "White" + } ], + "text": "White" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "56051-6", + "display": "Do you consider yourself Hispanic/Latino?" + } ], + "text": "Do you consider yourself Hispanic/Latino?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:8dc2089d-3117-6b00-a056-8cdbbaeebeb3", + "resource": { + "resourceType": "Observation", + "id": "8dc2089d-3117-6b00-a056-8cdbbaeebeb3", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T10:09:14+01:00", + "issued": "2019-08-18T10:09:14.201+01:00", + "valueQuantity": { + "value": 0, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:25028563-eec5-285b-a0c5-951b9bfd2b82", + "resource": { + "resourceType": "Observation", + "id": "25028563-eec5-285b-a0c5-951b9bfd2b82", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T10:50:35+01:00", + "issued": "2019-08-18T10:50:35.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:2c2cca8b-312a-01fc-8388-1e0169109915", + "resource": { + "resourceType": "Observation", + "id": "2c2cca8b-312a-01fc-8388-1e0169109915", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T11:28:49+01:00", + "issued": "2019-08-18T11:28:49.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:24bdc532-0150-4bc9-b7e7-8311faa04a98", + "resource": { + "resourceType": "Procedure", + "id": "24bdc532-0150-4bc9-b7e7-8311faa04a98", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "performedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:578d4230-c5e1-0923-3b0b-e82c76198bb3", + "resource": { + "resourceType": "Procedure", + "id": "578d4230-c5e1-0923-3b0b-e82c76198bb3", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "performedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:87b405ea-2be2-6cab-103c-9d834050e129", + "resource": { + "resourceType": "Procedure", + "id": "87b405ea-2be2-6cab-103c-9d834050e129", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "performedPeriod": { + "start": "2019-08-18T09:38:26+01:00", + "end": "2019-08-18T10:09:14+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:86134b9e-5950-0942-1fb2-a62deb5561bc", + "resource": { + "resourceType": "Procedure", + "id": "86134b9e-5950-0942-1fb2-a62deb5561bc", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "performedPeriod": { + "start": "2019-08-18T10:09:14+01:00", + "end": "2019-08-18T10:23:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:1516838a-9583-c2e8-a2f7-2011ee28fa4d", + "resource": { + "resourceType": "Procedure", + "id": "1516838a-9583-c2e8-a2f7-2011ee28fa4d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "performedPeriod": { + "start": "2019-08-18T10:23:58+01:00", + "end": "2019-08-18T10:50:35+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:97b3c02a-4740-35d9-f676-93c61b819603", + "resource": { + "resourceType": "Procedure", + "id": "97b3c02a-4740-35d9-f676-93c61b819603", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "performedPeriod": { + "start": "2019-08-18T10:50:35+01:00", + "end": "2019-08-18T11:02:13+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:34d26b47-672d-0be3-4eb4-565eb5c35bf2", + "resource": { + "resourceType": "Procedure", + "id": "34d26b47-672d-0be3-4eb4-565eb5c35bf2", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "performedPeriod": { + "start": "2019-08-18T11:02:13+01:00", + "end": "2019-08-18T11:28:49+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:fc2f8e05-b15d-e7d4-64f0-86bacd2ae887", + "resource": { + "resourceType": "Procedure", + "id": "fc2f8e05-b15d-e7d4-64f0-86bacd2ae887", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "performedPeriod": { + "start": "2019-08-18T11:28:49+01:00", + "end": "2019-08-18T11:39:31+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:bde251c9-848f-baaa-e49b-5dc069a66686", + "resource": { + "resourceType": "MedicationRequest", + "id": "bde251c9-848f-baaa-e49b-5dc069a66686", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "authoredOn": "2019-08-18T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:4d6d73f2-cf71-713d-124b-20bd93cbb55d", + "resource": { + "resourceType": "Claim", + "id": "4d6d73f2-cf71-713d-124b-20bd93cbb55d", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "created": "2019-08-18T09:38:26+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:bde251c9-848f-baaa-e49b-5dc069a66686" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "encounter": [ { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:71493639-ab0e-9051-868e-53576d240ceb", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "71493639-ab0e-9051-868e-53576d240ceb", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "4d6d73f2-cf71-713d-124b-20bd93cbb55d" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2019-08-18T09:38:26+01:00", + "end": "2020-08-18T09:38:26+01:00" + }, + "created": "2019-08-18T09:38:26+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:4d6d73f2-cf71-713d-124b-20bd93cbb55d" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "servicedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:7fc36101-da53-87c6-9e0e-316213772c1a", + "resource": { + "resourceType": "MedicationRequest", + "id": "7fc36101-da53-87c6-9e0e-316213772c1a", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "authoredOn": "2019-08-18T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:b6277851-2948-ed94-6db9-ad24a1819745", + "resource": { + "resourceType": "Claim", + "id": "b6277851-2948-ed94-6db9-ad24a1819745", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "created": "2019-08-18T09:38:26+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:7fc36101-da53-87c6-9e0e-316213772c1a" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "encounter": [ { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:b67b969e-018d-73bb-660e-d946a5312bfe", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "b67b969e-018d-73bb-660e-d946a5312bfe", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "b6277851-2948-ed94-6db9-ad24a1819745" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2019-08-18T09:38:26+01:00", + "end": "2020-08-18T09:38:26+01:00" + }, + "created": "2019-08-18T09:38:26+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:b6277851-2948-ed94-6db9-ad24a1819745" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "servicedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:70c923ab-167f-d37a-1f27-92ea0b5db84b", + "resource": { + "resourceType": "Immunization", + "id": "70c923ab-167f-d37a-1f27-92ea0b5db84b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "occurrenceDateTime": "2019-08-18T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:14e910a7-e2cd-9814-a1fd-62d34a4858f1", + "resource": { + "resourceType": "DiagnosticReport", + "id": "14e910a7-e2cd-9814-a1fd-62d34a4858f1", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "performer": [ { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } ], + "result": [ { + "reference": "urn:uuid:30349553-3bcf-5955-2a08-e578019d47c7", + "display": "Cholesterol [Mass/volume] in Serum or Plasma" + }, { + "reference": "urn:uuid:c3d76a0e-5a7d-ec80-0941-351db155bec9", + "display": "Triglycerides" + }, { + "reference": "urn:uuid:dca1f527-5066-a553-efad-96cc1432e49c", + "display": "Low Density Lipoprotein Cholesterol" + }, { + "reference": "urn:uuid:6b8486f4-56cc-b005-2e13-d9f085ef8921", + "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:e92e9f99-1fee-7d33-9054-a33a9dace1d2", + "resource": { + "resourceType": "DiagnosticReport", + "id": "e92e9f99-1fee-7d33-9054-a33a9dace1d2", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T10:09:14+01:00", + "issued": "2019-08-18T10:09:14.201+01:00", + "result": [ { + "reference": "urn:uuid:8dc2089d-3117-6b00-a056-8cdbbaeebeb3", + "display": "Total score [HARK]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:db745486-d1e0-48b1-d14b-ec706e4db0f1", + "resource": { + "resourceType": "DiagnosticReport", + "id": "db745486-d1e0-48b1-d14b-ec706e4db0f1", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T10:50:35+01:00", + "issued": "2019-08-18T10:50:35.201+01:00", + "result": [ { + "reference": "urn:uuid:25028563-eec5-285b-a0c5-951b9bfd2b82", + "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:2bd4b9f2-9b27-ab41-37d8-44ca40ce6f85", + "resource": { + "resourceType": "DiagnosticReport", + "id": "2bd4b9f2-9b27-ab41-37d8-44ca40ce6f85", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T11:28:49+01:00", + "issued": "2019-08-18T11:28:49.201+01:00", + "result": [ { + "reference": "urn:uuid:2c2cca8b-312a-01fc-8388-1e0169109915", + "display": "Total score [DAST-10]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:b24760b5-22ef-89f2-118d-024240b188a5", + "resource": { + "resourceType": "DiagnosticReport", + "id": "b24760b5-22ef-89f2-118d-024240b188a5", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, + "effectiveDateTime": "2019-08-18T08:41:58+01:00", + "issued": "2019-08-18T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:0ff48303-ea3b-0fcc-1fea-15fe1747f8ba", + "resource": { + "resourceType": "DocumentReference", + "id": "0ff48303-ea3b-0fcc-1fea-15fe1747f8ba", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:b24760b5-22ef-89f2-118d-024240b188a5" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2019-08-18T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:06613751-4755-cb2a-9f34-21ca6b387894" + } ], + "period": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:35c68e5b-f136-05b3-1c0e-1947a9792710", + "resource": { + "resourceType": "Claim", + "id": "35c68e5b-f136-05b3-1c0e-1947a9792710", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "created": "2019-08-18T09:38:26+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:70c923ab-167f-d37a-1f27-92ea0b5db84b" + } + }, { + "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:345d87a1-78fc-4fe1-6f3d-56dd1f539370" + } + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:d78955fb-cd7f-d17b-2f97-595ac8c30d33" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:24bdc532-0150-4bc9-b7e7-8311faa04a98" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:578d4230-c5e1-0923-3b0b-e82c76198bb3" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:87b405ea-2be2-6cab-103c-9d834050e129" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:86134b9e-5950-0942-1fb2-a62deb5561bc" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:1516838a-9583-c2e8-a2f7-2011ee28fa4d" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:97b3c02a-4740-35d9-f676-93c61b819603" + } + }, { + "sequence": 7, + "procedureReference": { + "reference": "urn:uuid:34d26b47-672d-0be3-4eb4-565eb5c35bf2" + } + }, { + "sequence": 8, + "procedureReference": { + "reference": "urn:uuid:fc2f8e05-b15d-e7d4-64f0-86bacd2ae887" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:06613751-4755-cb2a-9f34-21ca6b387894" + } ] + }, { + "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": 288.45, + "currency": "USD" + } + }, { + "sequence": 4, + "informationSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "57698-3", + "display": "Lipid panel with direct LDL - Serum or Plasma" + } ], + "text": "Lipid panel with direct LDL - Serum or Plasma" + }, + "net": { + "value": 74.58, + "currency": "USD" + } + }, { + "sequence": 5, + "procedureSequence": [ 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": 6, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "160904001", + "display": "Part-time employment (finding)" + } ], + "text": "Part-time employment (finding)" + } + }, { + "sequence": 7, + "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": 8, + "informationSequence": [ 3 ], + "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": 9, + "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": 10, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 11, + "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": 12, + "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": 13, + "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": 14, + "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" + } + }, { + "sequence": 15, + "diagnosisSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + } + }, { + "sequence": 16, + "procedureSequence": [ 8 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 1067.23, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:9c47a97a-a1a9-6e16-d072-33b4dd2d990f", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "9c47a97a-a1a9-6e16-d072-33b4dd2d990f", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "35c68e5b-f136-05b3-1c0e-1947a9792710" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2019-08-18T09:38:26+01:00", + "end": "2020-08-18T09:38:26+01:00" + }, + "created": "2019-08-18T09:38:26+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:35c68e5b-f136-05b3-1c0e-1947a9792710" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:345d87a1-78fc-4fe1-6f3d-56dd1f539370" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:d78955fb-cd7f-d17b-2f97-595ac8c30d33" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + } ] + }, { + "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": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "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": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 288.45, + "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": 57.69, + "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": 230.76, + "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": 288.45, + "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": 288.45, + "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://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": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 5, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "servicedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 6, + "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": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "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": "866148006", + "display": "Screening for domestic abuse (procedure)" + } ], + "text": "Screening for domestic abuse (procedure)" + }, + "servicedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 8, + "informationSequence": [ 3 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "76499-3", + "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" + } ], + "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" + }, + "servicedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "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": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "servicedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "servicedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": [ 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": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "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": "428211000124100", + "display": "Assessment of substance use (procedure)" + } ], + "text": "Assessment of substance use (procedure)" + }, + "servicedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "713106006", + "display": "Screening for drug abuse (procedure)" + } ], + "text": "Screening for drug abuse (procedure)" + }, + "servicedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": [ 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": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 15, + "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": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + }, + "servicedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "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": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "servicedPeriod": { + "start": "2019-08-18T08:41:58+01:00", + "end": "2019-08-18T09:38:26+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 1067.23, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 2994.056, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d", + "resource": { + "resourceType": "Encounter", + "id": "de7b173c-6207-27c6-6f76-7ef1fe68ed2d", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "66383009", + "display": "Gingivitis (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:34dbcc15-8cb5-1085-1750-24de19b46b1d", + "resource": { + "resourceType": "Condition", + "id": "34dbcc15-8cb5-1085-1750-24de19b46b1d", + "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": "18718003", + "display": "Gingival disease (disorder)" + } ], + "text": "Gingival disease (disorder)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "onsetDateTime": "2019-09-01T11:39:05+01:00", + "abatementDateTime": "2019-09-01T14:20:03+01:00", + "recordedDate": "2019-09-01T11:39:05+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:cf127688-5fcd-80bf-fd4f-a86ca5b62800", + "resource": { + "resourceType": "Procedure", + "id": "cf127688-5fcd-80bf-fd4f-a86ca5b62800", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "performedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T09:07:20+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:36e3a5f8-f487-175f-ccd1-df64be457b19", + "resource": { + "resourceType": "Procedure", + "id": "36e3a5f8-f487-175f-ccd1-df64be457b19", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "performedPeriod": { + "start": "2019-09-01T09:07:20+01:00", + "end": "2019-09-01T10:00:55+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:9ed0e812-0ac6-824f-a99b-239ff9d77b8f", + "resource": { + "resourceType": "Procedure", + "id": "9ed0e812-0ac6-824f-a99b-239ff9d77b8f", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "performedPeriod": { + "start": "2019-09-01T10:00:55+01:00", + "end": "2019-09-01T10:30:42+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:c6c1515d-e9fe-e3bf-1062-495652b59b90", + "resource": { + "resourceType": "Procedure", + "id": "c6c1515d-e9fe-e3bf-1062-495652b59b90", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "performedPeriod": { + "start": "2019-09-01T10:30:42+01:00", + "end": "2019-09-01T10:53:25+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:dd0ec517-0eb1-3b4a-9fdc-28c7799b4873", + "resource": { + "resourceType": "Procedure", + "id": "dd0ec517-0eb1-3b4a-9fdc-28c7799b4873", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "performedPeriod": { + "start": "2019-09-01T10:53:25+01:00", + "end": "2019-09-01T11:23:25+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:e84b8c4e-8f59-876c-7519-afcf723b07d4", + "resource": { + "resourceType": "Procedure", + "id": "e84b8c4e-8f59-876c-7519-afcf723b07d4", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "performedPeriod": { + "start": "2019-09-01T10:53:25+01:00", + "end": "2019-09-01T11:39:05+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:122c5ebd-6fcc-912b-c0a7-718e94792eb7", + "resource": { + "resourceType": "Procedure", + "id": "122c5ebd-6fcc-912b-c0a7-718e94792eb7", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "81733005", + "display": "Dental surgical procedure (procedure)" + } ], + "text": "Dental surgical procedure (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "performedPeriod": { + "start": "2019-09-01T11:39:05+01:00", + "end": "2019-09-01T11:51:42+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:a06dffbd-e266-8a2c-428d-9b57ae44a5c8", + "display": "Gingival disease (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:9edf3992-fed3-0745-f9a9-b26d148f9782", + "resource": { + "resourceType": "Procedure", + "id": "9edf3992-fed3-0745-f9a9-b26d148f9782", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "3802001", + "display": "Dental application of desensitizing medicament (procedure)" + } ], + "text": "Dental application of desensitizing medicament (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "performedPeriod": { + "start": "2019-09-01T11:51:42+01:00", + "end": "2019-09-01T13:08:21+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:a06dffbd-e266-8a2c-428d-9b57ae44a5c8", + "display": "Gingival disease (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:c9ccf4d1-3253-0d57-104c-44df18941c3a", + "resource": { + "resourceType": "Procedure", + "id": "c9ccf4d1-3253-0d57-104c-44df18941c3a", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "64544008", + "display": "Gingivectomy or gingivoplasty, per tooth (procedure)" + } ], + "text": "Gingivectomy or gingivoplasty, per tooth (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "performedPeriod": { + "start": "2019-09-01T13:08:21+01:00", + "end": "2019-09-01T14:20:03+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:a06dffbd-e266-8a2c-428d-9b57ae44a5c8", + "display": "Gingival disease (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:ea9b7994-b22e-c141-e4a9-8e1959316ea4", + "resource": { + "resourceType": "Procedure", + "id": "ea9b7994-b22e-c141-e4a9-8e1959316ea4", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "456191000124101", + "display": "Postoperative care for dental procedure (regime/therapy)" + } ], + "text": "Postoperative care for dental procedure (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "performedPeriod": { + "start": "2019-09-01T14:20:03+01:00", + "end": "2019-09-01T15:22:33+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:6731a298-d504-b917-3e54-1d83c16b6052", + "resource": { + "resourceType": "Procedure", + "id": "6731a298-d504-b917-3e54-1d83c16b6052", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "performedPeriod": { + "start": "2019-09-01T15:22:33+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:ae861a19-05d0-3c22-39e5-ab33c9899810", + "resource": { + "resourceType": "Device", + "id": "ae861a19-05d0-3c22-39e5-ab33c9899810", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ] + }, + "udiCarrier": [ { + "deviceIdentifier": "38046134251287", + "carrierHRF": "(01)38046134251287(11)190811(17)440825(10)2716984645(21)394705747314959" + } ], + "status": "active", + "distinctIdentifier": "38046134251287", + "manufactureDate": "2019-08-11T10:53:25+01:00", + "expirationDate": "2044-08-25T10:53:25+01:00", + "lotNumber": "2716984645", + "serialNumber": "394705747314959", + "deviceName": [ { + "name": "Dental x-ray system (physical object)", + "type": "user-friendly-name" + } ], + "type": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + } + }, + "request": { + "method": "POST", + "url": "Device" + } + }, { + "fullUrl": "urn:uuid:7282d936-356a-d7ae-351f-b31b61f21ac7", + "resource": { + "resourceType": "Device", + "id": "7282d936-356a-d7ae-351f-b31b61f21ac7", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ] + }, + "udiCarrier": [ { + "deviceIdentifier": "10314209510913", + "carrierHRF": "(01)10314209510913(11)190811(17)440825(10)22541756243756961(21)68640" + } ], + "status": "active", + "distinctIdentifier": "10314209510913", + "manufactureDate": "2019-08-11T11:39:05+01:00", + "expirationDate": "2044-08-25T11:39:05+01:00", + "lotNumber": "22541756243756961", + "serialNumber": "68640", + "deviceName": [ { + "name": "Operating room (environment)", + "type": "user-friendly-name" + } ], + "type": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225738002", + "display": "Operating room (environment)" + } ], + "text": "Operating room (environment)" + }, + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + } + }, + "request": { + "method": "POST", + "url": "Device" + } + }, { + "fullUrl": "urn:uuid:07e8e1eb-b585-3bd5-9a75-f389a9fcfedc", + "resource": { + "resourceType": "SupplyDelivery", + "id": "07e8e1eb-b585-3bd5-9a75-f389a9fcfedc", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + } + }, + "occurrenceDateTime": "2019-09-01T10:00:55+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:ba36ab8a-4526-e098-1938-61870688b61b", + "resource": { + "resourceType": "SupplyDelivery", + "id": "ba36ab8a-4526-e098-1938-61870688b61b", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + } + }, + "occurrenceDateTime": "2019-09-01T10:00:55+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:f2f4cda6-a1c8-9396-d766-15db68af271e", + "resource": { + "resourceType": "SupplyDelivery", + "id": "f2f4cda6-a1c8-9396-d766-15db68af271e", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + } + }, + "occurrenceDateTime": "2019-09-01T10:00:55+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:5f3ddcf5-4d4f-fa29-8a95-c52923bc235f", + "resource": { + "resourceType": "ImagingStudy", + "id": "5f3ddcf5-4d4f-fa29-8a95-c52923bc235f", + "identifier": [ { + "use": "official", + "system": "urn:ietf:rfc:3986", + "value": "urn:oid:1.2.840.99999999.80876618.1567331605201" + } ], + "status": "available", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "started": "2019-09-01T10:53:25+01:00", + "numberOfSeries": 1, + "numberOfInstances": 1, + "procedureCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + } ], + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "series": [ { + "uid": "1.2.840.99999999.1.15093151.1567331605201", + "number": 1, + "modality": { + "system": "http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html", + "code": "DX", + "display": "Digital Radiography" + }, + "numberOfInstances": 1, + "bodySite": { + "system": "http://snomed.info/sct", + "code": "700016008", + "display": "Structure of region of internal part of mouth (body structure)" + }, + "started": "2019-09-01T10:53:25+01:00", + "instance": [ { + "uid": "1.2.840.99999999.1.1.33606159.1567331605201", + "sopClass": { + "system": "urn:ietf:rfc:3986", + "code": "urn:oid:1.2.840.10008.5.1.4.1.1.1.3" + }, + "number": 1, + "title": "Digital Intra-Oral X-Ray Image" + } ] + } ] + }, + "request": { + "method": "POST", + "url": "ImagingStudy" + } + }, { + "fullUrl": "urn:uuid:288a917c-8995-416c-5597-7a6a998ad466", + "resource": { + "resourceType": "DiagnosticReport", + "id": "288a917c-8995-416c-5597-7a6a998ad466", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, + "effectiveDateTime": "2019-09-01T08:41:58+01:00", + "issued": "2019-09-01T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:5976eebe-021e-cfb7-060e-c02665664037", + "resource": { + "resourceType": "DocumentReference", + "id": "5976eebe-021e-cfb7-060e-c02665664037", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:288a917c-8995-416c-5597-7a6a998ad466" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2019-09-01T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + } ], + "period": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:246be321-9339-5ce9-7c78-576444aa48f9", + "resource": { + "resourceType": "Claim", + "id": "246be321-9339-5ce9-7c78-576444aa48f9", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "created": "2019-09-01T15:40:05+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "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" + } ] + } + }, { + "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:34dbcc15-8cb5-1085-1750-24de19b46b1d" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:cf127688-5fcd-80bf-fd4f-a86ca5b62800" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:36e3a5f8-f487-175f-ccd1-df64be457b19" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:9ed0e812-0ac6-824f-a99b-239ff9d77b8f" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:c6c1515d-e9fe-e3bf-1062-495652b59b90" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:dd0ec517-0eb1-3b4a-9fdc-28c7799b4873" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:e84b8c4e-8f59-876c-7519-afcf723b07d4" + } + }, { + "sequence": 7, + "procedureReference": { + "reference": "urn:uuid:122c5ebd-6fcc-912b-c0a7-718e94792eb7" + } + }, { + "sequence": 8, + "procedureReference": { + "reference": "urn:uuid:9edf3992-fed3-0745-f9a9-b26d148f9782" + } + }, { + "sequence": 9, + "procedureReference": { + "reference": "urn:uuid:c9ccf4d1-3253-0d57-104c-44df18941c3a" + } + }, { + "sequence": 10, + "procedureReference": { + "reference": "urn:uuid:ea9b7994-b22e-c141-e4a9-8e1959316ea4" + } + }, { + "sequence": 11, + "procedureReference": { + "reference": "urn:uuid:6731a298-d504-b917-3e54-1d83c16b6052" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185349003", + "display": "Encounter for check up (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + } ] + }, { + "sequence": 2, + "procedureSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 3, + "procedureSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 4, + "informationSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 5, + "informationSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 6, + "informationSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 7, + "procedureSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 8, + "procedureSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 9, + "informationSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 10, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 11, + "procedureSequence": [ 6 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 12, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "18718003", + "display": "Gingival disease (disorder)" + } ], + "text": "Gingival disease (disorder)" + } + }, { + "sequence": 13, + "informationSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225738002", + "display": "Operating room (environment)" + } ], + "text": "Operating room (environment)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 14, + "procedureSequence": [ 7 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "81733005", + "display": "Dental surgical procedure (procedure)" + } ], + "text": "Dental surgical procedure (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 15, + "procedureSequence": [ 8 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "3802001", + "display": "Dental application of desensitizing medicament (procedure)" + } ], + "text": "Dental application of desensitizing medicament (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 16, + "procedureSequence": [ 9 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "64544008", + "display": "Gingivectomy or gingivoplasty, per tooth (procedure)" + } ], + "text": "Gingivectomy or gingivoplasty, per tooth (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 17, + "procedureSequence": [ 10 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "456191000124101", + "display": "Postoperative care for dental procedure (regime/therapy)" + } ], + "text": "Postoperative care for dental procedure (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 18, + "procedureSequence": [ 11 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 4830.95, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:796617ef-c3cf-bb71-8426-a5c2a65e4a52", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "796617ef-c3cf-bb71-8426-a5c2a65e4a52", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "246be321-9339-5ce9-7c78-576444aa48f9" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2019-09-01T15:40:05+01:00", + "end": "2020-09-01T15:40:05+01:00" + }, + "created": "2019-09-01T15:40:05+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:246be321-9339-5ce9-7c78-576444aa48f9" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:34dbcc15-8cb5-1085-1750-24de19b46b1d" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + } ] + }, { + "sequence": 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": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": [ 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": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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, + "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": "18718003", + "display": "Gingival disease (disorder)" + } ], + "text": "Gingival disease (disorder)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + } + }, { + "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://snomed.info/sct", + "code": "225738002", + "display": "Operating room (environment)" + } ], + "text": "Operating room (environment)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "81733005", + "display": "Dental surgical procedure (procedure)" + } ], + "text": "Dental surgical procedure (procedure)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "3802001", + "display": "Dental application of desensitizing medicament (procedure)" + } ], + "text": "Dental application of desensitizing medicament (procedure)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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, + "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": "64544008", + "display": "Gingivectomy or gingivoplasty, per tooth (procedure)" + } ], + "text": "Gingivectomy or gingivoplasty, per tooth (procedure)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "456191000124101", + "display": "Postoperative care for dental procedure (regime/therapy)" + } ], + "text": "Postoperative care for dental procedure (regime/therapy)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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, + "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": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "servicedPeriod": { + "start": "2019-09-01T08:41:58+01:00", + "end": "2019-09-01T15:40:05+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 4830.95, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 3796.3199999999993, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10", + "resource": { + "resourceType": "Encounter", + "id": "e0032b03-1c7a-e822-0744-1c071e698e10", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "e0032b03-1c7a-e822-0744-1c071e698e10" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:639649eb-3121-ddee-9e14-796fded96ae0", + "resource": { + "resourceType": "Condition", + "id": "639649eb-3121-ddee-9e14-796fded96ae0", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "onsetDateTime": "2020-08-23T08:41:58+01:00", + "abatementDateTime": "2024-09-15T08:41:58+01:00", + "recordedDate": "2020-08-23T08:41:58+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:6ce88523-0479-4114-94db-bae334419f23", + "resource": { + "resourceType": "Condition", + "id": "6ce88523-0479-4114-94db-bae334419f23", + "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": "422650009", + "display": "Social isolation (finding)" + } ], + "text": "Social isolation (finding)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "onsetDateTime": "2020-08-23T09:12:08+01:00", + "abatementDateTime": "2021-08-29T09:21:36+01:00", + "recordedDate": "2020-08-23T09:12:08+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:3ae59a87-91cf-2148-a2ad-599dd6d850ee", + "resource": { + "resourceType": "Condition", + "id": "3ae59a87-91cf-2148-a2ad-599dd6d850ee", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "onsetDateTime": "2020-08-23T09:12:08+01:00", + "abatementDateTime": "2021-08-29T09:21:36+01:00", + "recordedDate": "2020-08-23T09:12:08+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:895d2cdc-bd99-0209-edd8-fff1274a91c2", + "resource": { + "resourceType": "Observation", + "id": "895d2cdc-bd99-0209-edd8-fff1274a91c2", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T08:41:58+01:00", + "issued": "2020-08-23T08:41:58.201+01:00", + "valueQuantity": { + "value": 168.8, + "unit": "cm", + "system": "http://unitsofmeasure.org", + "code": "cm" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:0f8b0d61-35f8-d71c-dd39-674e7b5b80c7", + "resource": { + "resourceType": "Observation", + "id": "0f8b0d61-35f8-d71c-dd39-674e7b5b80c7", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T08:41:58+01:00", + "issued": "2020-08-23T08:41:58.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:ee679726-e65b-fffc-9dfa-bf9992096bb9", + "resource": { + "resourceType": "Observation", + "id": "ee679726-e65b-fffc-9dfa-bf9992096bb9", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T08:41:58+01:00", + "issued": "2020-08-23T08:41:58.201+01:00", + "valueQuantity": { + "value": 86.8, + "unit": "kg", + "system": "http://unitsofmeasure.org", + "code": "kg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:34d2ae48-e63a-185d-431c-2642b63bb9cc", + "resource": { + "resourceType": "Observation", + "id": "34d2ae48-e63a-185d-431c-2642b63bb9cc", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T08:41:58+01:00", + "issued": "2020-08-23T08:41:58.201+01:00", + "valueQuantity": { + "value": 30.46, + "unit": "kg/m2", + "system": "http://unitsofmeasure.org", + "code": "kg/m2" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c7f443cd-874a-f245-60a4-4370b7c13b7c", + "resource": { + "resourceType": "Observation", + "id": "c7f443cd-874a-f245-60a4-4370b7c13b7c", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T08:41:58+01:00", + "issued": "2020-08-23T08:41:58.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "8462-4", + "display": "Diastolic Blood Pressure" + } ], + "text": "Diastolic Blood Pressure" + }, + "valueQuantity": { + "value": 94, + "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": 105, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:79374e32-7456-4d67-27d0-5aa2bfd94826", + "resource": { + "resourceType": "Observation", + "id": "79374e32-7456-4d67-27d0-5aa2bfd94826", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T08:41:58+01:00", + "issued": "2020-08-23T08:41:58.201+01:00", + "valueQuantity": { + "value": 79, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:509d39f1-1e9b-96f9-eebd-64e7c8b8bb97", + "resource": { + "resourceType": "Observation", + "id": "509d39f1-1e9b-96f9-eebd-64e7c8b8bb97", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T08:41:58+01:00", + "issued": "2020-08-23T08:41:58.201+01:00", + "valueQuantity": { + "value": 13, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:3f381250-5c63-0604-9124-be1ee4b7e0cf", + "resource": { + "resourceType": "Observation", + "id": "3f381250-5c63-0604-9124-be1ee4b7e0cf", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T08:41:58+01:00", + "issued": "2020-08-23T08:41:58.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "8517006", + "display": "Ex-smoker (finding)" + } ], + "text": "Ex-smoker (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:facdd3ed-5de2-97e0-4f8b-89f55c5a8275", + "resource": { + "resourceType": "Observation", + "id": "facdd3ed-5de2-97e0-4f8b-89f55c5a8275", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T09:12:08+01:00", + "issued": "2020-08-23T09:12:08.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "76501-6", + "display": "Within the last year, have you been afraid of your partner or ex-partner?" + } ], + "text": "Within the last year, have you been afraid of your partner or ex-partner?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93026-3", + "display": "Do you feel physically and emotionally safe where you currently live?" + } ], + "text": "Do you feel physically and emotionally safe where you currently live?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA33-6", + "display": "Yes" + } ], + "text": "Yes" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93027-1", + "display": "Are you a refugee?" + } ], + "text": "Are you a refugee?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93028-9", + "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + } ], + "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93038-8", + "display": "Stress level" + } ], + "text": "Stress level" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA13863-8", + "display": "A little bit" + } ], + "text": "A little bit" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93029-7", + "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + } ], + "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA27722-0", + "display": "Less than once a week" + } ], + "text": "Less than once a week" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93030-5", + "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + } ], + "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93031-3", + "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + } ], + "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30125-1", + "display": "Food" + } ], + "text": "Food" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63586-2", + "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + } ], + "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + }, + "valueQuantity": { + "value": 60262, + "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": "627 Ullrich Dam Unit 88" + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93033-9", + "display": "Are you worried about losing your housing?" + } ], + "text": "Are you worried about losing your housing?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "71802-3", + "display": "Housing status" + } ], + "text": "Housing status" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30189-7", + "display": "I have housing" + } ], + "text": "I have housing" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63512-8", + "display": "How many people are living or staying at this address?" + } ], + "text": "How many people are living or staying at this address?" + }, + "valueQuantity": { + "value": 7, + "unit": "{#}", + "system": "http://unitsofmeasure.org", + "code": "{#}" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "54899-0", + "display": "Preferred language" + } ], + "text": "Preferred language" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA43-5", + "display": "English" + } ], + "text": "English" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93034-7", + "display": "Have you been discharged from the armed forces of the United States?" + } ], + "text": "Have you been discharged from the armed forces of the United States?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93035-4", + "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + } ], + "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "32624-9", + "display": "Race" + } ], + "text": "Race" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA4457-3", + "display": "White" + } ], + "text": "White" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "56051-6", + "display": "Do you consider yourself Hispanic/Latino?" + } ], + "text": "Do you consider yourself Hispanic/Latino?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:888ab828-bc48-50b3-b2a4-40dee36e26da", + "resource": { + "resourceType": "Observation", + "id": "888ab828-bc48-50b3-b2a4-40dee36e26da", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T09:51:32+01:00", + "issued": "2020-08-23T09:51:32.201+01:00", + "valueQuantity": { + "value": 0, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:8f6c83f9-e0ff-734f-36b0-eff3796a268d", + "resource": { + "resourceType": "Observation", + "id": "8f6c83f9-e0ff-734f-36b0-eff3796a268d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T10:35:42+01:00", + "issued": "2020-08-23T10:35:42.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c41e7d71-dd69-7e96-2045-54a20f1a4881", + "resource": { + "resourceType": "Procedure", + "id": "c41e7d71-dd69-7e96-2045-54a20f1a4881", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "performedPeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:6c5c4ead-2dbe-af34-7fee-ea5166218744", + "resource": { + "resourceType": "Procedure", + "id": "6c5c4ead-2dbe-af34-7fee-ea5166218744", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "performedPeriod": { + "start": "2020-08-23T09:12:08+01:00", + "end": "2020-08-23T09:51:32+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:23f98d60-2636-0a34-f246-4758d6bc5769", + "resource": { + "resourceType": "Procedure", + "id": "23f98d60-2636-0a34-f246-4758d6bc5769", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "performedPeriod": { + "start": "2020-08-23T09:51:32+01:00", + "end": "2020-08-23T10:05:54+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:b195bb97-cdf9-4d09-a0f1-0a56d028f6af", + "resource": { + "resourceType": "Procedure", + "id": "b195bb97-cdf9-4d09-a0f1-0a56d028f6af", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "performedPeriod": { + "start": "2020-08-23T10:05:54+01:00", + "end": "2020-08-23T10:35:42+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:1d44cbbe-9a1e-c75b-ff0d-42476f98bc13", + "resource": { + "resourceType": "MedicationRequest", + "id": "1d44cbbe-9a1e-c75b-ff0d-42476f98bc13", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "authoredOn": "2020-08-23T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:8c9df7f3-0c2a-1f29-9ff5-dd7792a2fee8", + "resource": { + "resourceType": "Claim", + "id": "8c9df7f3-0c2a-1f29-9ff5-dd7792a2fee8", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "created": "2020-08-23T09:12:08+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:1d44cbbe-9a1e-c75b-ff0d-42476f98bc13" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "encounter": [ { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:823428be-69ef-f835-c97b-9943e6f0dad6", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "823428be-69ef-f835-c97b-9943e6f0dad6", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "8c9df7f3-0c2a-1f29-9ff5-dd7792a2fee8" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2020-08-23T09:12:08+01:00", + "end": "2021-08-23T09:12:08+01:00" + }, + "created": "2020-08-23T09:12:08+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:8c9df7f3-0c2a-1f29-9ff5-dd7792a2fee8" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "servicedPeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:e55ae35f-d452-875f-83d3-dbef2772584a", + "resource": { + "resourceType": "MedicationRequest", + "id": "e55ae35f-d452-875f-83d3-dbef2772584a", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "authoredOn": "2020-08-23T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:2764c20b-e983-c2ea-67d9-47d7695493b6", + "resource": { + "resourceType": "Claim", + "id": "2764c20b-e983-c2ea-67d9-47d7695493b6", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "created": "2020-08-23T09:12:08+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:e55ae35f-d452-875f-83d3-dbef2772584a" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "encounter": [ { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:35071234-368e-2868-290a-9cb953abea7e", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "35071234-368e-2868-290a-9cb953abea7e", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "2764c20b-e983-c2ea-67d9-47d7695493b6" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2020-08-23T09:12:08+01:00", + "end": "2021-08-23T09:12:08+01:00" + }, + "created": "2020-08-23T09:12:08+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:2764c20b-e983-c2ea-67d9-47d7695493b6" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "servicedPeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:8cda3b56-0b02-fb62-66ea-64e7d461f27c", + "resource": { + "resourceType": "Immunization", + "id": "8cda3b56-0b02-fb62-66ea-64e7d461f27c", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "occurrenceDateTime": "2020-08-23T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:65d71f2d-5fe4-e2b9-8661-ea0917fc3f72", + "resource": { + "resourceType": "Immunization", + "id": "65d71f2d-5fe4-e2b9-8661-ea0917fc3f72", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "occurrenceDateTime": "2020-08-23T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:833869ef-a571-5471-8603-b787b72e6f0d", + "resource": { + "resourceType": "DiagnosticReport", + "id": "833869ef-a571-5471-8603-b787b72e6f0d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T09:51:32+01:00", + "issued": "2020-08-23T09:51:32.201+01:00", + "result": [ { + "reference": "urn:uuid:888ab828-bc48-50b3-b2a4-40dee36e26da", + "display": "Total score [HARK]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:bf8f070e-6686-4d6b-db00-665dac9ffbcf", + "resource": { + "resourceType": "DiagnosticReport", + "id": "bf8f070e-6686-4d6b-db00-665dac9ffbcf", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T10:35:42+01:00", + "issued": "2020-08-23T10:35:42.201+01:00", + "result": [ { + "reference": "urn:uuid:8f6c83f9-e0ff-734f-36b0-eff3796a268d", + "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:57879f8b-b7cb-914f-403b-d12f700b679b", + "resource": { + "resourceType": "DiagnosticReport", + "id": "57879f8b-b7cb-914f-403b-d12f700b679b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, + "effectiveDateTime": "2020-08-23T08:41:58+01:00", + "issued": "2020-08-23T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:12a828f2-23a5-862a-115a-8837c532a3ec", + "resource": { + "resourceType": "DocumentReference", + "id": "12a828f2-23a5-862a-115a-8837c532a3ec", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:57879f8b-b7cb-914f-403b-d12f700b679b" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2020-08-23T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:e0032b03-1c7a-e822-0744-1c071e698e10" + } ], + "period": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:b23f4642-2b7d-c23f-d8e7-3d525185e0d3", + "resource": { + "resourceType": "Claim", + "id": "b23f4642-2b7d-c23f-d8e7-3d525185e0d3", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "created": "2020-08-23T09:12:08+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:8cda3b56-0b02-fb62-66ea-64e7d461f27c" + } + }, { + "sequence": 2, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:65d71f2d-5fe4-e2b9-8661-ea0917fc3f72" + } + }, { + "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:639649eb-3121-ddee-9e14-796fded96ae0" + } + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:6ce88523-0479-4114-94db-bae334419f23" + } + }, { + "sequence": 3, + "diagnosisReference": { + "reference": "urn:uuid:3ae59a87-91cf-2148-a2ad-599dd6d850ee" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:c41e7d71-dd69-7e96-2045-54a20f1a4881" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:6c5c4ead-2dbe-af34-7fee-ea5166218744" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:23f98d60-2636-0a34-f246-4758d6bc5769" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:b195bb97-cdf9-4d09-a0f1-0a56d028f6af" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:e0032b03-1c7a-e822-0744-1c071e698e10" + } ] + }, { + "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": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 6, + "diagnosisSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "422650009", + "display": "Social isolation (finding)" + } ], + "text": "Social isolation (finding)" + } + }, { + "sequence": 7, + "diagnosisSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "73595000", + "display": "Stress (finding)" + } ], + "text": "Stress (finding)" + } + }, { + "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": [ 3 ], + "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": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (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" + } + } ], + "total": { + "value": 840.20, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:d74b1199-fd9d-9f71-2b74-7a880e4d3f8e", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "d74b1199-fd9d-9f71-2b74-7a880e4d3f8e", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "b23f4642-2b7d-c23f-d8e7-3d525185e0d3" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2020-08-23T09:12:08+01:00", + "end": "2021-08-23T09:12:08+01:00" + }, + "created": "2020-08-23T09:12:08+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:b23f4642-2b7d-c23f-d8e7-3d525185e0d3" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:639649eb-3121-ddee-9e14-796fded96ae0" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:6ce88523-0479-4114-94db-bae334419f23" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + }, { + "sequence": 3, + "diagnosisReference": { + "reference": "urn:uuid:3ae59a87-91cf-2148-a2ad-599dd6d850ee" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "162673000", + "display": "General examination of patient (procedure)" + } ], + "text": "General examination of patient (procedure)" + }, + "servicedPeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + } ] + }, { + "sequence": 2, + "informationSequence": [ 1 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://hl7.org/fhir/sid/cvx", + "code": "140", + "display": "Influenza, seasonal, injectable, preservative free" + } ], + "text": "Influenza, seasonal, injectable, preservative free" + }, + "servicedPeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "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": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "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": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "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": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "servicedPeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 6, + "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": "422650009", + "display": "Social isolation (finding)" + } ], + "text": "Social isolation (finding)" + }, + "servicedPeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "sequence": 7, + "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": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "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": "866148006", + "display": "Screening for domestic abuse (procedure)" + } ], + "text": "Screening for domestic abuse (procedure)" + }, + "servicedPeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "76499-3", + "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" + } ], + "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" + }, + "servicedPeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "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": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "servicedPeriod": { + "start": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "2020-08-23T08:41:58+01:00", + "end": "2020-08-23T09:12:08+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 840.20, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 1717.4080000000001, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:c10aa468-a113-3b89-7b04-5ce3eae8ff85", + "resource": { + "resourceType": "Encounter", + "id": "c10aa468-a113-3b89-7b04-5ce3eae8ff85", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "c10aa468-a113-3b89-7b04-5ce3eae8ff85" + } ], + "status": "finished", + "class": { + "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", + "code": "AMB" + }, + "type": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2020-12-30T23:41:58+01:00", + "end": "2020-12-30T23:56:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2020-12-30T23:41:58+01:00", + "end": "2020-12-30T23:56:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "195967001", + "display": "Asthma (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:342229ab-18e4-1708-2232-1f3e131123f1", + "resource": { + "resourceType": "DiagnosticReport", + "id": "342229ab-18e4-1708-2232-1f3e131123f1", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:c10aa468-a113-3b89-7b04-5ce3eae8ff85" + }, + "effectiveDateTime": "2020-12-30T23:41:58+01:00", + "issued": "2020-12-30T23:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:9a65ec95-c3fc-c454-02c9-340643a95c26", + "resource": { + "resourceType": "DocumentReference", + "id": "9a65ec95-c3fc-c454-02c9-340643a95c26", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:342229ab-18e4-1708-2232-1f3e131123f1" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2020-12-30T23:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:c10aa468-a113-3b89-7b04-5ce3eae8ff85" + } ], + "period": { + "start": "2020-12-30T23:41:58+01:00", + "end": "2020-12-30T23:56:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:404160ca-9087-59fc-3fe4-e0ef8a53772f", + "resource": { + "resourceType": "Claim", + "id": "404160ca-9087-59fc-3fe4-e0ef8a53772f", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2020-12-30T23:41:58+01:00", + "end": "2020-12-30T23:56:58+01:00" + }, + "created": "2020-12-30T23:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "encounter": [ { + "reference": "urn:uuid:c10aa468-a113-3b89-7b04-5ce3eae8ff85" + } ] + } ], + "total": { + "value": 142.58, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:a50a9c8c-ac92-2305-44c4-d6c830be5e7e", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "a50a9c8c-ac92-2305-44c4-d6c830be5e7e", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "404160ca-9087-59fc-3fe4-e0ef8a53772f" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2020-12-30T23:56:58+01:00", + "end": "2021-12-30T23:56:58+01:00" + }, + "created": "2020-12-30T23:56:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:404160ca-9087-59fc-3fe4-e0ef8a53772f" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "servicedPeriod": { + "start": "2020-12-30T23:41:58+01:00", + "end": "2020-12-30T23:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:c10aa468-a113-3b89-7b04-5ce3eae8ff85" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 142.58, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504", + "resource": { + "resourceType": "Encounter", + "id": "07531b39-aefd-127b-1544-7fac8bf03504", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "07531b39-aefd-127b-1544-7fac8bf03504" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:09b2c873-1960-8651-58c4-d3878f6a87fd", + "resource": { + "resourceType": "Condition", + "id": "09b2c873-1960-8651-58c4-d3878f6a87fd", + "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": "73438004", + "display": "Unemployed (finding)" + } ], + "text": "Unemployed (finding)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "onsetDateTime": "2021-08-29T09:21:36+01:00", + "abatementDateTime": "2022-09-04T09:22:22+01:00", + "recordedDate": "2021-08-29T09:21:36+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:21c68e1d-fceb-dc07-8c87-8807f2e5e4e2", + "resource": { + "resourceType": "Condition", + "id": "21c68e1d-fceb-dc07-8c87-8807f2e5e4e2", + "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": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "onsetDateTime": "2021-08-29T11:04:29+01:00", + "abatementDateTime": "2021-09-12T10:59:56+01:00", + "recordedDate": "2021-08-29T11:04:29+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:2e37b68b-011a-6346-6f50-725d2a5380f4", + "resource": { + "resourceType": "Observation", + "id": "2e37b68b-011a-6346-6f50-725d2a5380f4", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 168.8, + "unit": "cm", + "system": "http://unitsofmeasure.org", + "code": "cm" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:33bde865-08c4-c7e1-e9dc-02fdc3a52e96", + "resource": { + "resourceType": "Observation", + "id": "33bde865-08c4-c7e1-e9dc-02fdc3a52e96", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 2, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:bbcef629-fb49-2506-fb9d-fdac53cf04d4", + "resource": { + "resourceType": "Observation", + "id": "bbcef629-fb49-2506-fb9d-fdac53cf04d4", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 86.8, + "unit": "kg", + "system": "http://unitsofmeasure.org", + "code": "kg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:97dd5a92-0d99-630d-83f9-066bb2fecbaa", + "resource": { + "resourceType": "Observation", + "id": "97dd5a92-0d99-630d-83f9-066bb2fecbaa", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 30.46, + "unit": "kg/m2", + "system": "http://unitsofmeasure.org", + "code": "kg/m2" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:95934d59-422b-db0d-94cd-2eac98f24089", + "resource": { + "resourceType": "Observation", + "id": "95934d59-422b-db0d-94cd-2eac98f24089", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "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": 107, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:222b0963-8dc6-498f-efc4-d80689c26bbe", + "resource": { + "resourceType": "Observation", + "id": "222b0963-8dc6-498f-efc4-d80689c26bbe", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 96, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:556b95e9-3e72-a7c6-df33-4564eb91fd3d", + "resource": { + "resourceType": "Observation", + "id": "556b95e9-3e72-a7c6-df33-4564eb91fd3d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 15, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:def9fcd8-7041-50a0-ff7d-529f1a3d0a2f", + "resource": { + "resourceType": "Observation", + "id": "def9fcd8-7041-50a0-ff7d-529f1a3d0a2f", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 3.7951, + "unit": "10*3/uL", + "system": "http://unitsofmeasure.org", + "code": "10*3/uL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:6c80a9c0-284f-d35c-bf8d-d2b7c333382d", + "resource": { + "resourceType": "Observation", + "id": "6c80a9c0-284f-d35c-bf8d-d2b7c333382d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 4.3066, + "unit": "10*6/uL", + "system": "http://unitsofmeasure.org", + "code": "10*6/uL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:7df80ed6-34b1-9abd-6641-52abb1474586", + "resource": { + "resourceType": "Observation", + "id": "7df80ed6-34b1-9abd-6641-52abb1474586", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 14.039, + "unit": "g/dL", + "system": "http://unitsofmeasure.org", + "code": "g/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:236790d7-419e-f0f6-0092-8c24ac236c84", + "resource": { + "resourceType": "Observation", + "id": "236790d7-419e-f0f6-0092-8c24ac236c84", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 48.083, + "unit": "%", + "system": "http://unitsofmeasure.org", + "code": "%" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:bdbd30fb-ee5c-37cf-de96-bb437764f024", + "resource": { + "resourceType": "Observation", + "id": "bdbd30fb-ee5c-37cf-de96-bb437764f024", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 90.32, + "unit": "fL", + "system": "http://unitsofmeasure.org", + "code": "fL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:4652f639-74f6-c297-f816-6cff6308de32", + "resource": { + "resourceType": "Observation", + "id": "4652f639-74f6-c297-f816-6cff6308de32", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 32.387, + "unit": "pg", + "system": "http://unitsofmeasure.org", + "code": "pg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:0533a36d-d1a7-2b94-107d-c97eb1eb835c", + "resource": { + "resourceType": "Observation", + "id": "0533a36d-d1a7-2b94-107d-c97eb1eb835c", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 34.575, + "unit": "g/dL", + "system": "http://unitsofmeasure.org", + "code": "g/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:eae79b43-f482-f0eb-4a51-02e334f6e9d7", + "resource": { + "resourceType": "Observation", + "id": "eae79b43-f482-f0eb-4a51-02e334f6e9d7", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 41.378, + "unit": "fL", + "system": "http://unitsofmeasure.org", + "code": "fL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:75718bef-126b-853f-62e8-0c7bf36ab5ad", + "resource": { + "resourceType": "Observation", + "id": "75718bef-126b-853f-62e8-0c7bf36ab5ad", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 382.32, + "unit": "10*3/uL", + "system": "http://unitsofmeasure.org", + "code": "10*3/uL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:e0dd6c0c-73b4-5e70-b939-5f70ac7fd9cf", + "resource": { + "resourceType": "Observation", + "id": "e0dd6c0c-73b4-5e70-b939-5f70ac7fd9cf", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 213.08, + "unit": "fL", + "system": "http://unitsofmeasure.org", + "code": "fL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:1ce9c759-3243-f943-a16d-2931686b8774", + "resource": { + "resourceType": "Observation", + "id": "1ce9c759-3243-f943-a16d-2931686b8774", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueQuantity": { + "value": 10.011, + "unit": "fL", + "system": "http://unitsofmeasure.org", + "code": "fL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:5ad91d4d-69d8-6d7e-1207-d93eb549de93", + "resource": { + "resourceType": "Observation", + "id": "5ad91d4d-69d8-6d7e-1207-d93eb549de93", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "8517006", + "display": "Ex-smoker (finding)" + } ], + "text": "Ex-smoker (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:77d17e37-1d98-7c7a-0ff4-e416c0daf56e", + "resource": { + "resourceType": "Observation", + "id": "77d17e37-1d98-7c7a-0ff4-e416c0daf56e", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T09:21:36+01:00", + "issued": "2021-08-29T09:21:36.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "76501-6", + "display": "Within the last year, have you been afraid of your partner or ex-partner?" + } ], + "text": "Within the last year, have you been afraid of your partner or ex-partner?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93026-3", + "display": "Do you feel physically and emotionally safe where you currently live?" + } ], + "text": "Do you feel physically and emotionally safe where you currently live?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA33-6", + "display": "Yes" + } ], + "text": "Yes" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93027-1", + "display": "Are you a refugee?" + } ], + "text": "Are you a refugee?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93028-9", + "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + } ], + "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93038-8", + "display": "Stress level" + } ], + "text": "Stress level" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA6568-5", + "display": "Not at all" + } ], + "text": "Not at all" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93029-7", + "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + } ], + "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30132-7", + "display": "5 or more times a week" + } ], + "text": "5 or more times a week" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93030-5", + "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + } ], + "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93031-3", + "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + } ], + "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30125-1", + "display": "Food" + } ], + "text": "Food" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63586-2", + "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + } ], + "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + }, + "valueQuantity": { + "value": 60262, + "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": "LA17956-6", + "display": "Unemployed" + } ], + "text": "Unemployed" + } + }, { + "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": "627 Ullrich Dam Unit 88" + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93033-9", + "display": "Are you worried about losing your housing?" + } ], + "text": "Are you worried about losing your housing?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "71802-3", + "display": "Housing status" + } ], + "text": "Housing status" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30189-7", + "display": "I have housing" + } ], + "text": "I have housing" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63512-8", + "display": "How many people are living or staying at this address?" + } ], + "text": "How many people are living or staying at this address?" + }, + "valueQuantity": { + "value": 7, + "unit": "{#}", + "system": "http://unitsofmeasure.org", + "code": "{#}" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "54899-0", + "display": "Preferred language" + } ], + "text": "Preferred language" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA43-5", + "display": "English" + } ], + "text": "English" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93034-7", + "display": "Have you been discharged from the armed forces of the United States?" + } ], + "text": "Have you been discharged from the armed forces of the United States?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93035-4", + "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + } ], + "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "32624-9", + "display": "Race" + } ], + "text": "Race" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA4457-3", + "display": "White" + } ], + "text": "White" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "56051-6", + "display": "Do you consider yourself Hispanic/Latino?" + } ], + "text": "Do you consider yourself Hispanic/Latino?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:45ba5a8b-1498-0a29-c60b-ed0e6182bba7", + "resource": { + "resourceType": "Observation", + "id": "45ba5a8b-1498-0a29-c60b-ed0e6182bba7", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T09:49:37+01:00", + "issued": "2021-08-29T09:49:37.201+01:00", + "valueQuantity": { + "value": 13, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:4d15a32f-0316-7b88-ffcd-6e69ea7a7df6", + "resource": { + "resourceType": "Observation", + "id": "4d15a32f-0316-7b88-ffcd-6e69ea7a7df6", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T10:22:53+01:00", + "issued": "2021-08-29T10:22:53.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:d3b17ae6-d64f-639d-edd8-3669518708c8", + "resource": { + "resourceType": "Observation", + "id": "d3b17ae6-d64f-639d-edd8-3669518708c8", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T11:04:29+01:00", + "issued": "2021-08-29T11:04:29.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:6118c25d-1f2e-115f-8b27-178c27ed6fd1", + "resource": { + "resourceType": "Procedure", + "id": "6118c25d-1f2e-115f-8b27-178c27ed6fd1", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "performedPeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:8e65ccfa-5558-a1bf-9a90-d48ff862d62b", + "resource": { + "resourceType": "Procedure", + "id": "8e65ccfa-5558-a1bf-9a90-d48ff862d62b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "performedPeriod": { + "start": "2021-08-29T09:21:36+01:00", + "end": "2021-08-29T09:49:37+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:542ee982-6708-4c5f-97a4-6f1a2e699796", + "resource": { + "resourceType": "Procedure", + "id": "542ee982-6708-4c5f-97a4-6f1a2e699796", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "performedPeriod": { + "start": "2021-08-29T09:49:37+01:00", + "end": "2021-08-29T10:00:09+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:390c2c7e-f0d1-ac3a-08a9-eaef6e48f795", + "resource": { + "resourceType": "Procedure", + "id": "390c2c7e-f0d1-ac3a-08a9-eaef6e48f795", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "performedPeriod": { + "start": "2021-08-29T10:00:09+01:00", + "end": "2021-08-29T10:22:53+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:7dacd15f-ce76-5823-ad85-2a9f192acc99", + "resource": { + "resourceType": "Procedure", + "id": "7dacd15f-ce76-5823-ad85-2a9f192acc99", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "performedPeriod": { + "start": "2021-08-29T10:22:53+01:00", + "end": "2021-08-29T10:35:13+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:ce40185d-82e2-2fca-3e08-3f21ba842980", + "resource": { + "resourceType": "Procedure", + "id": "ce40185d-82e2-2fca-3e08-3f21ba842980", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "performedPeriod": { + "start": "2021-08-29T10:35:13+01:00", + "end": "2021-08-29T11:04:29+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:b497b936-65dd-a9b5-bb62-15989d28c167", + "resource": { + "resourceType": "Procedure", + "id": "b497b936-65dd-a9b5-bb62-15989d28c167", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "performedPeriod": { + "start": "2021-08-29T11:04:29+01:00", + "end": "2021-08-29T11:16:37+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:318981f8-b539-f318-29ae-7ccdb658a661", + "resource": { + "resourceType": "MedicationRequest", + "id": "318981f8-b539-f318-29ae-7ccdb658a661", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "authoredOn": "2021-08-29T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:5cf9df02-55fc-9649-1701-081426dfb3f2", + "resource": { + "resourceType": "Claim", + "id": "5cf9df02-55fc-9649-1701-081426dfb3f2", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "created": "2021-08-29T09:21:36+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:318981f8-b539-f318-29ae-7ccdb658a661" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "encounter": [ { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:7da951ef-ce20-215c-b7e4-d61ca4fa20e6", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "7da951ef-ce20-215c-b7e4-d61ca4fa20e6", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "5cf9df02-55fc-9649-1701-081426dfb3f2" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2021-08-29T09:21:36+01:00", + "end": "2022-08-29T09:21:36+01:00" + }, + "created": "2021-08-29T09:21:36+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:5cf9df02-55fc-9649-1701-081426dfb3f2" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "servicedPeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:78bdcaea-018e-1f58-5696-d67902bf43a8", + "resource": { + "resourceType": "MedicationRequest", + "id": "78bdcaea-018e-1f58-5696-d67902bf43a8", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "authoredOn": "2021-08-29T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:137533fc-2d99-cea0-01ef-1df9ed39d89c", + "resource": { + "resourceType": "Claim", + "id": "137533fc-2d99-cea0-01ef-1df9ed39d89c", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "created": "2021-08-29T09:21:36+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:78bdcaea-018e-1f58-5696-d67902bf43a8" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "encounter": [ { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:d86a92ba-0db4-5273-d693-fba81e67addb", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "d86a92ba-0db4-5273-d693-fba81e67addb", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "137533fc-2d99-cea0-01ef-1df9ed39d89c" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2021-08-29T09:21:36+01:00", + "end": "2022-08-29T09:21:36+01:00" + }, + "created": "2021-08-29T09:21:36+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:137533fc-2d99-cea0-01ef-1df9ed39d89c" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "servicedPeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:e9549d06-1caf-9275-8158-5ca7f6a1e552", + "resource": { + "resourceType": "Immunization", + "id": "e9549d06-1caf-9275-8158-5ca7f6a1e552", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "occurrenceDateTime": "2021-08-29T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:a6ea53b6-42f1-ea19-1321-79aca99f6643", + "resource": { + "resourceType": "Immunization", + "id": "a6ea53b6-42f1-ea19-1321-79aca99f6643", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "occurrenceDateTime": "2021-08-29T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:0c0965c4-d2ce-95e7-b5bb-fb371ecfecc0", + "resource": { + "resourceType": "Immunization", + "id": "0c0965c4-d2ce-95e7-b5bb-fb371ecfecc0", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "occurrenceDateTime": "2021-08-29T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:7d2d4382-62f1-ca85-b57f-24f34734d2e0", + "resource": { + "resourceType": "DiagnosticReport", + "id": "7d2d4382-62f1-ca85-b57f-24f34734d2e0", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "performer": [ { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } ], + "result": [ { + "reference": "urn:uuid:def9fcd8-7041-50a0-ff7d-529f1a3d0a2f", + "display": "Leukocytes [#/volume] in Blood by Automated count" + }, { + "reference": "urn:uuid:6c80a9c0-284f-d35c-bf8d-d2b7c333382d", + "display": "Erythrocytes [#/volume] in Blood by Automated count" + }, { + "reference": "urn:uuid:7df80ed6-34b1-9abd-6641-52abb1474586", + "display": "Hemoglobin [Mass/volume] in Blood" + }, { + "reference": "urn:uuid:236790d7-419e-f0f6-0092-8c24ac236c84", + "display": "Hematocrit [Volume Fraction] of Blood by Automated count" + }, { + "reference": "urn:uuid:bdbd30fb-ee5c-37cf-de96-bb437764f024", + "display": "MCV [Entitic volume] by Automated count" + }, { + "reference": "urn:uuid:4652f639-74f6-c297-f816-6cff6308de32", + "display": "MCH [Entitic mass] by Automated count" + }, { + "reference": "urn:uuid:0533a36d-d1a7-2b94-107d-c97eb1eb835c", + "display": "MCHC [Mass/volume] by Automated count" + }, { + "reference": "urn:uuid:eae79b43-f482-f0eb-4a51-02e334f6e9d7", + "display": "Erythrocyte distribution width [Entitic volume] by Automated count" + }, { + "reference": "urn:uuid:75718bef-126b-853f-62e8-0c7bf36ab5ad", + "display": "Platelets [#/volume] in Blood by Automated count" + }, { + "reference": "urn:uuid:e0dd6c0c-73b4-5e70-b939-5f70ac7fd9cf", + "display": "Platelet distribution width [Entitic volume] in Blood by Automated count" + }, { + "reference": "urn:uuid:1ce9c759-3243-f943-a16d-2931686b8774", + "display": "Platelet mean volume [Entitic volume] in Blood by Automated count" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:d124c492-653a-8b46-ca2e-e70da1a82c7f", + "resource": { + "resourceType": "DiagnosticReport", + "id": "d124c492-653a-8b46-ca2e-e70da1a82c7f", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T09:49:37+01:00", + "issued": "2021-08-29T09:49:37.201+01:00", + "result": [ { + "reference": "urn:uuid:45ba5a8b-1498-0a29-c60b-ed0e6182bba7", + "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:85a9c190-5d04-8bbf-03a8-56b7425b07ea", + "resource": { + "resourceType": "DiagnosticReport", + "id": "85a9c190-5d04-8bbf-03a8-56b7425b07ea", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T10:22:53+01:00", + "issued": "2021-08-29T10:22:53.201+01:00", + "result": [ { + "reference": "urn:uuid:4d15a32f-0316-7b88-ffcd-6e69ea7a7df6", + "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:8b63b92b-c27b-7e04-3efa-f01c28edc1d3", + "resource": { + "resourceType": "DiagnosticReport", + "id": "8b63b92b-c27b-7e04-3efa-f01c28edc1d3", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T11:04:29+01:00", + "issued": "2021-08-29T11:04:29.201+01:00", + "result": [ { + "reference": "urn:uuid:d3b17ae6-d64f-639d-edd8-3669518708c8", + "display": "Total score [AUDIT-C]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:0dd89f89-0d7e-797e-f68c-d12cc5be4fc9", + "resource": { + "resourceType": "DiagnosticReport", + "id": "0dd89f89-0d7e-797e-f68c-d12cc5be4fc9", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, + "effectiveDateTime": "2021-08-29T08:41:58+01:00", + "issued": "2021-08-29T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:c1299ea4-aba5-9495-bfdb-fdea4d32b257", + "resource": { + "resourceType": "DocumentReference", + "id": "c1299ea4-aba5-9495-bfdb-fdea4d32b257", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:0dd89f89-0d7e-797e-f68c-d12cc5be4fc9" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2021-08-29T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:07531b39-aefd-127b-1544-7fac8bf03504" + } ], + "period": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:587da5a6-62e7-a10c-ba64-18a51ed4ad22", + "resource": { + "resourceType": "Claim", + "id": "587da5a6-62e7-a10c-ba64-18a51ed4ad22", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "created": "2021-08-29T09:21:36+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:e9549d06-1caf-9275-8158-5ca7f6a1e552" + } + }, { + "sequence": 2, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:a6ea53b6-42f1-ea19-1321-79aca99f6643" + } + }, { + "sequence": 3, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:0c0965c4-d2ce-95e7-b5bb-fb371ecfecc0" + } + }, { + "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:09b2c873-1960-8651-58c4-d3878f6a87fd" + } + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:21c68e1d-fceb-dc07-8c87-8807f2e5e4e2" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:6118c25d-1f2e-115f-8b27-178c27ed6fd1" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:8e65ccfa-5558-a1bf-9a90-d48ff862d62b" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:542ee982-6708-4c5f-97a4-6f1a2e699796" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:390c2c7e-f0d1-ac3a-08a9-eaef6e48f795" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:7dacd15f-ce76-5823-ad85-2a9f192acc99" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:ce40185d-82e2-2fca-3e08-3f21ba842980" + } + }, { + "sequence": 7, + "procedureReference": { + "reference": "urn:uuid:b497b936-65dd-a9b5-bb62-15989d28c167" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:07531b39-aefd-127b-1544-7fac8bf03504" + } ] + }, { + "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, + "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": 6, + "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": 7, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "73438004", + "display": "Unemployed (finding)" + } ], + "text": "Unemployed (finding)" + } + }, { + "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": "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": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (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" + } + }, { + "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": "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": 15, + "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" + } + }, { + "sequence": 16, + "diagnosisSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + } + }, { + "sequence": 17, + "procedureSequence": [ 7 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 1050.78, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:9643c55f-37b0-b632-ff31-d6129318b45b", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "9643c55f-37b0-b632-ff31-d6129318b45b", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "587da5a6-62e7-a10c-ba64-18a51ed4ad22" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2021-08-29T09:21:36+01:00", + "end": "2022-08-29T09:21:36+01:00" + }, + "created": "2021-08-29T09:21:36+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:587da5a6-62e7-a10c-ba64-18a51ed4ad22" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:09b2c873-1960-8651-58c4-d3878f6a87fd" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:21c68e1d-fceb-dc07-8c87-8807f2e5e4e2" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + } ] + }, { + "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": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "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": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "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": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "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, + "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": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "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": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "73438004", + "display": "Unemployed (finding)" + } ], + "text": "Unemployed (finding)" + }, + "servicedPeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "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": "710841007", + "display": "Assessment of anxiety (procedure)" + } ], + "text": "Assessment of anxiety (procedure)" + }, + "servicedPeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "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": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "servicedPeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "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": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "763302001", + "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" + } ], + "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" + }, + "servicedPeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": [ 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": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 16, + "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": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + }, + "servicedPeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "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": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "servicedPeriod": { + "start": "2021-08-29T08:41:58+01:00", + "end": "2021-08-29T09:21:36+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 1050.78, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 2980.896, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1", + "resource": { + "resourceType": "Encounter", + "id": "fcf9634e-70d2-ccc9-f50a-4f78443a54b1", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "66383009", + "display": "Gingivitis (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:c7f52b84-0950-6580-257e-633d625d1d51", + "resource": { + "resourceType": "Condition", + "id": "c7f52b84-0950-6580-257e-633d625d1d51", + "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": "278598003", + "display": "Leaking dental filling (finding)" + } ], + "text": "Leaking dental filling (finding)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, + "onsetDateTime": "2021-09-12T10:59:56+01:00", + "abatementDateTime": "2021-09-12T11:19:25+01:00", + "recordedDate": "2021-09-12T10:59:56+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:5e081646-b540-7946-eea6-19e5b8188737", + "resource": { + "resourceType": "Procedure", + "id": "5e081646-b540-7946-eea6-19e5b8188737", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, + "performedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T09:05:42+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:27f43a81-9e80-623b-991d-d3fa61dcb961", + "resource": { + "resourceType": "Procedure", + "id": "27f43a81-9e80-623b-991d-d3fa61dcb961", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, + "performedPeriod": { + "start": "2021-09-12T09:05:42+01:00", + "end": "2021-09-12T09:32:33+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:121d5201-09c5-46bc-6908-03424156b865", + "resource": { + "resourceType": "Procedure", + "id": "121d5201-09c5-46bc-6908-03424156b865", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, + "performedPeriod": { + "start": "2021-09-12T09:32:33+01:00", + "end": "2021-09-12T10:07:01+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:afa8c5b1-ad22-81ac-f1e5-721eb1360221", + "resource": { + "resourceType": "Procedure", + "id": "afa8c5b1-ad22-81ac-f1e5-721eb1360221", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, + "performedPeriod": { + "start": "2021-09-12T10:07:01+01:00", + "end": "2021-09-12T10:28:28+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:54e17884-7ef5-174a-7d49-c5f3463a6480", + "resource": { + "resourceType": "Procedure", + "id": "54e17884-7ef5-174a-7d49-c5f3463a6480", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, + "performedPeriod": { + "start": "2021-09-12T10:28:28+01:00", + "end": "2021-09-12T10:58:28+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:abe9a9be-a2c2-8d6b-7cfb-8c073f8d67e2", + "resource": { + "resourceType": "Procedure", + "id": "abe9a9be-a2c2-8d6b-7cfb-8c073f8d67e2", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, + "performedPeriod": { + "start": "2021-09-12T10:28:28+01:00", + "end": "2021-09-12T10:59:56+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:9dd239de-9c4b-3f10-4e1c-b411ef401536", + "resource": { + "resourceType": "Procedure", + "id": "9dd239de-9c4b-3f10-4e1c-b411ef401536", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1256042007", + "display": "Restoration of tooth with coverage of all cusps using dental filling material (procedure)" + } ], + "text": "Restoration of tooth with coverage of all cusps using dental filling material (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, + "performedPeriod": { + "start": "2021-09-12T10:59:56+01:00", + "end": "2021-09-12T11:19:25+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:c7f52b84-0950-6580-257e-633d625d1d51", + "display": "Leaking dental filling (finding)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:4da92f7a-97e6-f046-dbd6-44ced35117af", + "resource": { + "resourceType": "Procedure", + "id": "4da92f7a-97e6-f046-dbd6-44ced35117af", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, + "performedPeriod": { + "start": "2021-09-12T11:19:25+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:15e24a56-f16b-04e4-24c5-243c849ea518", + "resource": { + "resourceType": "Device", + "id": "15e24a56-f16b-04e4-24c5-243c849ea518", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ] + }, + "udiCarrier": [ { + "deviceIdentifier": "82725116263416", + "carrierHRF": "(01)82725116263416(11)210822(17)460906(10)3708821283(21)4916698227199232" + } ], + "status": "active", + "distinctIdentifier": "82725116263416", + "manufactureDate": "2021-08-22T10:28:28+01:00", + "expirationDate": "2046-09-06T10:28:28+01:00", + "lotNumber": "3708821283", + "serialNumber": "4916698227199232", + "deviceName": [ { + "name": "Dental x-ray system (physical object)", + "type": "user-friendly-name" + } ], + "type": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + } + }, + "request": { + "method": "POST", + "url": "Device" + } + }, { + "fullUrl": "urn:uuid:563ba90c-dc50-16e8-c7c3-184a15016212", + "resource": { + "resourceType": "SupplyDelivery", + "id": "563ba90c-dc50-16e8-c7c3-184a15016212", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + } + }, + "occurrenceDateTime": "2021-09-12T09:32:33+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:5152a9a0-e36e-8c35-8e75-1ff74400d1e5", + "resource": { + "resourceType": "SupplyDelivery", + "id": "5152a9a0-e36e-8c35-8e75-1ff74400d1e5", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + } + }, + "occurrenceDateTime": "2021-09-12T09:32:33+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:d3e2d793-f2ec-8799-fc7b-592e0aa9277f", + "resource": { + "resourceType": "SupplyDelivery", + "id": "d3e2d793-f2ec-8799-fc7b-592e0aa9277f", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + } + }, + "occurrenceDateTime": "2021-09-12T09:32:33+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:28b021b5-115c-19df-be5d-5b5c062041c5", + "resource": { + "resourceType": "ImagingStudy", + "id": "28b021b5-115c-19df-be5d-5b5c062041c5", + "identifier": [ { + "use": "official", + "system": "urn:ietf:rfc:3986", + "value": "urn:oid:1.2.840.99999999.47873801.1631438908201" + } ], + "status": "available", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, + "started": "2021-09-12T10:28:28+01:00", + "numberOfSeries": 1, + "numberOfInstances": 1, + "procedureCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + } ], + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "series": [ { + "uid": "1.2.840.99999999.1.58601646.1631438908201", + "number": 1, + "modality": { + "system": "http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html", + "code": "DX", + "display": "Digital Radiography" + }, + "numberOfInstances": 1, + "bodySite": { + "system": "http://snomed.info/sct", + "code": "700016008", + "display": "Structure of region of internal part of mouth (body structure)" + }, + "started": "2021-09-12T10:28:28+01:00", + "instance": [ { + "uid": "1.2.840.99999999.1.1.40405964.1631438908201", + "sopClass": { + "system": "urn:ietf:rfc:3986", + "code": "urn:oid:1.2.840.10008.5.1.4.1.1.1.3" + }, + "number": 1, + "title": "Digital Intra-Oral X-Ray Image" + } ] + } ] + }, + "request": { + "method": "POST", + "url": "ImagingStudy" + } + }, { + "fullUrl": "urn:uuid:de4d58c4-fa81-32d2-f71f-34e4e5a7272c", + "resource": { + "resourceType": "DiagnosticReport", + "id": "de4d58c4-fa81-32d2-f71f-34e4e5a7272c", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, + "effectiveDateTime": "2021-09-12T08:41:58+01:00", + "issued": "2021-09-12T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "DQoyMDIxLTA5LTEyDQoNCiMgQ2hpZWYgQ29tcGxhaW50DQotIENoZXN0IFByZXNzdXJlDQoNCg0KIyBIaXN0b3J5IG9mIFByZXNlbnQgSWxsbmVzcw0KSGVyYmVydDgzMA0KIGlzIGEgNDEgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIGdpbmdpdmFsIGRpc2Vhc2UgKGRpc29yZGVyKSwgcGFydC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBwYXJ0aWFsIHRoaWNrbmVzcyBidXJuIChkaXNvcmRlciksIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKSwgdW5oZWFsdGh5IGFsY29ob2wgZHJpbmtpbmcgYmVoYXZpb3IgKGZpbmRpbmcpLCB1bmVtcGxveWVkIChmaW5kaW5nKSwgZnVsbC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBhY3V0ZSBpbmZlY3RpdmUgY3lzdGl0aXMgKGRpc29yZGVyKSwgZ2luZ2l2aXRpcyAoZGlzb3JkZXIpLCBzdHJlc3MgKGZpbmRpbmcpLCBidXJuIGluanVyeSAobW9ycGhvbG9naWMgYWJub3JtYWxpdHkpLCBzb2NpYWwgaXNvbGF0aW9uIChmaW5kaW5nKS4NCg0KIyBTb2NpYWwgSGlzdG9yeQ0KUGF0aWVudCBpcyBtYXJyaWVkLiBQYXRpZW50IHF1aXQgc21va2luZyBhdCBhZ2UgMTYuDQogUGF0aWVudCBpZGVudGlmaWVzIGFzIGhldGVyb3NleHVhbC4NCg0KUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4NCiBQYXRpZW50IGhhcyBjb21wbGV0ZWQgc29tZSBjb2xsZWdlIGNvdXJzZXMuDQpQYXRpZW50IGN1cnJlbnRseSBoYXMgQW50aGVtLg0KDQojIEFsbGVyZ2llcw0KTm8gS25vd24gQWxsZXJnaWVzLg0KDQojIE1lZGljYXRpb25zDQpuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXTsgYWNldGFtaW5vcGhlbiAzMjUgbWcgLyBveHljb2RvbmUgaHlkcm9jaGxvcmlkZSA1IG1nIG9yYWwgdGFibGV0OyBjZWZkaW5pcjsgbmFwcm94ZW4gc29kaXVtIDIyMCBtZyBvcmFsIHRhYmxldDsgYnVkZXNvbmlkZSAwLjI1IG1nL21sIGluaGFsYXRpb24gc3VzcGVuc2lvbjsgY2lwcm9mbG94YWNpbiA1MDAgbWcgb3JhbCB0YWJsZXQNCg0KIyBBc3Nlc3NtZW50IGFuZCBQbGFuDQpQYXRpZW50IGlzIHByZXNlbnRpbmcgd2l0aCBsZWFraW5nIGRlbnRhbCBmaWxsaW5nIChmaW5kaW5nKS4gDQoNCg0KIyMgUGxhbg0KDQpUaGUgZm9sbG93aW5nIHByb2NlZHVyZXMgd2VyZSBjb25kdWN0ZWQ6DQotIGRlbnRhbCBjb25zdWx0YXRpb24gYW5kIHJlcG9ydCAocHJvY2VkdXJlKQ0KLSBkZW50YWwgY2FyZSAocmVnaW1lL3RoZXJhcHkpDQotIHJlbW92YWwgb2Ygc3VwcmFnaW5naXZhbCBwbGFxdWUgYW5kIGNhbGN1bHVzIGZyb20gYWxsIHRlZXRoIHVzaW5nIGRlbnRhbCBpbnN0cnVtZW50IChwcm9jZWR1cmUpDQotIHJlbW92YWwgb2Ygc3ViZ2luZ2l2YWwgcGxhcXVlIGFuZCBjYWxjdWx1cyBmcm9tIGFsbCB0ZWV0aCB1c2luZyBkZW50YWwgaW5zdHJ1bWVudCAocHJvY2VkdXJlKQ0KLSBkZW50YWwgcGxhaW4geC1yYXkgYml0ZXdpbmcgKHByb2NlZHVyZSkNCi0gZXhhbWluYXRpb24gb2YgZ2luZ2l2YWUgKHByb2NlZHVyZSkNCi0gcmVzdG9yYXRpb24gb2YgdG9vdGggd2l0aCBjb3ZlcmFnZSBvZiBhbGwgY3VzcHMgdXNpbmcgZGVudGFsIGZpbGxpbmcgbWF0ZXJpYWwgKHByb2NlZHVyZSkNCi0gb3JhbCBoZWFsdGggZWR1Y2F0aW9uIChwcm9jZWR1cmUpDQo=" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:e0b18a4f-a7a9-82b2-1054-5b16368a820c", + "resource": { + "resourceType": "DocumentReference", + "id": "e0b18a4f-a7a9-82b2-1054-5b16368a820c", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:de4d58c4-fa81-32d2-f71f-34e4e5a7272c" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2021-09-12T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "content": [ { + "attachment": { + "contentType": "text/plain; charset=utf-8", + "data": "DQoyMDIxLTA5LTEyDQoNCiMgQ2hpZWYgQ29tcGxhaW50DQotIENoZXN0IFByZXNzdXJlDQoNCg0KIyBIaXN0b3J5IG9mIFByZXNlbnQgSWxsbmVzcw0KSGVyYmVydDgzMA0KIGlzIGEgNDEgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIGdpbmdpdmFsIGRpc2Vhc2UgKGRpc29yZGVyKSwgcGFydC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBwYXJ0aWFsIHRoaWNrbmVzcyBidXJuIChkaXNvcmRlciksIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKSwgdW5oZWFsdGh5IGFsY29ob2wgZHJpbmtpbmcgYmVoYXZpb3IgKGZpbmRpbmcpLCB1bmVtcGxveWVkIChmaW5kaW5nKSwgZnVsbC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBhY3V0ZSBpbmZlY3RpdmUgY3lzdGl0aXMgKGRpc29yZGVyKSwgZ2luZ2l2aXRpcyAoZGlzb3JkZXIpLCBzdHJlc3MgKGZpbmRpbmcpLCBidXJuIGluanVyeSAobW9ycGhvbG9naWMgYWJub3JtYWxpdHkpLCBzb2NpYWwgaXNvbGF0aW9uIChmaW5kaW5nKS4NCg0KIyBTb2NpYWwgSGlzdG9yeQ0KUGF0aWVudCBpcyBtYXJyaWVkLiBQYXRpZW50IHF1aXQgc21va2luZyBhdCBhZ2UgMTYuDQogUGF0aWVudCBpZGVudGlmaWVzIGFzIGhldGVyb3NleHVhbC4NCg0KUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4NCiBQYXRpZW50IGhhcyBjb21wbGV0ZWQgc29tZSBjb2xsZWdlIGNvdXJzZXMuDQpQYXRpZW50IGN1cnJlbnRseSBoYXMgQW50aGVtLg0KDQojIEFsbGVyZ2llcw0KTm8gS25vd24gQWxsZXJnaWVzLg0KDQojIE1lZGljYXRpb25zDQpuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXTsgYWNldGFtaW5vcGhlbiAzMjUgbWcgLyBveHljb2RvbmUgaHlkcm9jaGxvcmlkZSA1IG1nIG9yYWwgdGFibGV0OyBjZWZkaW5pcjsgbmFwcm94ZW4gc29kaXVtIDIyMCBtZyBvcmFsIHRhYmxldDsgYnVkZXNvbmlkZSAwLjI1IG1nL21sIGluaGFsYXRpb24gc3VzcGVuc2lvbjsgY2lwcm9mbG94YWNpbiA1MDAgbWcgb3JhbCB0YWJsZXQNCg0KIyBBc3Nlc3NtZW50IGFuZCBQbGFuDQpQYXRpZW50IGlzIHByZXNlbnRpbmcgd2l0aCBsZWFraW5nIGRlbnRhbCBmaWxsaW5nIChmaW5kaW5nKS4gDQoNCg0KIyMgUGxhbg0KDQpUaGUgZm9sbG93aW5nIHByb2NlZHVyZXMgd2VyZSBjb25kdWN0ZWQ6DQotIGRlbnRhbCBjb25zdWx0YXRpb24gYW5kIHJlcG9ydCAocHJvY2VkdXJlKQ0KLSBkZW50YWwgY2FyZSAocmVnaW1lL3RoZXJhcHkpDQotIHJlbW92YWwgb2Ygc3VwcmFnaW5naXZhbCBwbGFxdWUgYW5kIGNhbGN1bHVzIGZyb20gYWxsIHRlZXRoIHVzaW5nIGRlbnRhbCBpbnN0cnVtZW50IChwcm9jZWR1cmUpDQotIHJlbW92YWwgb2Ygc3ViZ2luZ2l2YWwgcGxhcXVlIGFuZCBjYWxjdWx1cyBmcm9tIGFsbCB0ZWV0aCB1c2luZyBkZW50YWwgaW5zdHJ1bWVudCAocHJvY2VkdXJlKQ0KLSBkZW50YWwgcGxhaW4geC1yYXkgYml0ZXdpbmcgKHByb2NlZHVyZSkNCi0gZXhhbWluYXRpb24gb2YgZ2luZ2l2YWUgKHByb2NlZHVyZSkNCi0gcmVzdG9yYXRpb24gb2YgdG9vdGggd2l0aCBjb3ZlcmFnZSBvZiBhbGwgY3VzcHMgdXNpbmcgZGVudGFsIGZpbGxpbmcgbWF0ZXJpYWwgKHByb2NlZHVyZSkNCi0gb3JhbCBoZWFsdGggZWR1Y2F0aW9uIChwcm9jZWR1cmUpDQo=" + }, + "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:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + } ], + "period": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:4bc41cfa-be2b-764e-99b1-a85c396d3ac0", + "resource": { + "resourceType": "Claim", + "id": "4bc41cfa-be2b-764e-99b1-a85c396d3ac0", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "created": "2021-09-12T11:36:43+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "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" + } ] + } + }, { + "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:c7f52b84-0950-6580-257e-633d625d1d51" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:5e081646-b540-7946-eea6-19e5b8188737" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:27f43a81-9e80-623b-991d-d3fa61dcb961" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:121d5201-09c5-46bc-6908-03424156b865" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:afa8c5b1-ad22-81ac-f1e5-721eb1360221" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:54e17884-7ef5-174a-7d49-c5f3463a6480" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:abe9a9be-a2c2-8d6b-7cfb-8c073f8d67e2" + } + }, { + "sequence": 7, + "procedureReference": { + "reference": "urn:uuid:9dd239de-9c4b-3f10-4e1c-b411ef401536" + } + }, { + "sequence": 8, + "procedureReference": { + "reference": "urn:uuid:4da92f7a-97e6-f046-dbd6-44ced35117af" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185349003", + "display": "Encounter for check up (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + } ] + }, { + "sequence": 2, + "procedureSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 3, + "procedureSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 4, + "informationSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 5, + "informationSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 6, + "informationSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 7, + "procedureSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 8, + "procedureSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 9, + "informationSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 10, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 11, + "procedureSequence": [ 6 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 12, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "278598003", + "display": "Leaking dental filling (finding)" + } ], + "text": "Leaking dental filling (finding)" + } + }, { + "sequence": 13, + "procedureSequence": [ 7 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1256042007", + "display": "Restoration of tooth with coverage of all cusps using dental filling material (procedure)" + } ], + "text": "Restoration of tooth with coverage of all cusps using dental filling material (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 14, + "procedureSequence": [ 8 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 3536.75, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:c2d59c9d-0222-96eb-5ed1-40ae496a0771", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "c2d59c9d-0222-96eb-5ed1-40ae496a0771", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "4bc41cfa-be2b-764e-99b1-a85c396d3ac0" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2021-09-12T11:36:43+01:00", + "end": "2022-09-12T11:36:43+01:00" + }, + "created": "2021-09-12T11:36:43+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:4bc41cfa-be2b-764e-99b1-a85c396d3ac0" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:c7f52b84-0950-6580-257e-633d625d1d51" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + } ] + }, { + "sequence": 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": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": [ 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": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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, + "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": "278598003", + "display": "Leaking dental filling (finding)" + } ], + "text": "Leaking dental filling (finding)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + } + }, { + "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": "1256042007", + "display": "Restoration of tooth with coverage of all cusps using dental filling material (procedure)" + } ], + "text": "Restoration of tooth with coverage of all cusps using dental filling material (procedure)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "servicedPeriod": { + "start": "2021-09-12T08:41:58+01:00", + "end": "2021-09-12T11:36:43+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 3536.75, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 2760.9599999999996, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:a71a136b-1c13-32bf-93e3-1c6751c8c730", + "resource": { + "resourceType": "Encounter", + "id": "a71a136b-1c13-32bf-93e3-1c6751c8c730", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "a71a136b-1c13-32bf-93e3-1c6751c8c730" + } ], + "status": "finished", + "class": { + "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", + "code": "AMB" + }, + "type": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2021-12-25T23:41:58+01:00", + "end": "2021-12-25T23:56:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2021-12-25T23:41:58+01:00", + "end": "2021-12-25T23:56:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "195967001", + "display": "Asthma (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:ad4ea853-b11b-261f-6f4d-5ab2f6bcb33d", + "resource": { + "resourceType": "DiagnosticReport", + "id": "ad4ea853-b11b-261f-6f4d-5ab2f6bcb33d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:a71a136b-1c13-32bf-93e3-1c6751c8c730" + }, + "effectiveDateTime": "2021-12-25T23:41:58+01:00", + "issued": "2021-12-25T23:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "DQoyMDIxLTEyLTI1DQoNCiMgQ2hpZWYgQ29tcGxhaW50DQotIENoZXN0IFByZXNzdXJlDQoNCg0KIyBIaXN0b3J5IG9mIFByZXNlbnQgSWxsbmVzcw0KSGVyYmVydDgzMA0KIGlzIGEgNDEgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIGdpbmdpdmFsIGRpc2Vhc2UgKGRpc29yZGVyKSwgcGFydGlhbCB0aGlja25lc3MgYnVybiAoZGlzb3JkZXIpLCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIHVuZW1wbG95ZWQgKGZpbmRpbmcpLCBsZWFraW5nIGRlbnRhbCBmaWxsaW5nIChmaW5kaW5nKSwgYnVybiBpbmp1cnkgKG1vcnBob2xvZ2ljIGFibm9ybWFsaXR5KSwgcGFydC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCB1bmhlYWx0aHkgYWxjb2hvbCBkcmlua2luZyBiZWhhdmlvciAoZmluZGluZyksIGZ1bGwtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgYWN1dGUgaW5mZWN0aXZlIGN5c3RpdGlzIChkaXNvcmRlciksIGdpbmdpdml0aXMgKGRpc29yZGVyKSwgc3RyZXNzIChmaW5kaW5nKSwgc29jaWFsIGlzb2xhdGlvbiAoZmluZGluZykuDQoNCiMgU29jaWFsIEhpc3RvcnkNClBhdGllbnQgaXMgbWFycmllZC4gUGF0aWVudCBxdWl0IHNtb2tpbmcgYXQgYWdlIDE2Lg0KIFBhdGllbnQgaWRlbnRpZmllcyBhcyBoZXRlcm9zZXh1YWwuDQoNClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuDQogUGF0aWVudCBoYXMgY29tcGxldGVkIHNvbWUgY29sbGVnZSBjb3Vyc2VzLg0KUGF0aWVudCBjdXJyZW50bHkgaGFzIEFudGhlbS4NCg0KIyBBbGxlcmdpZXMNCk5vIEtub3duIEFsbGVyZ2llcy4NCg0KIyBNZWRpY2F0aW9ucw0KbmRhMDIwOTgzIDIwMCBhY3R1YXQgYWxidXRlcm9sIDAuMDkgbWcvYWN0dWF0IG1ldGVyZWQgZG9zZSBpbmhhbGVyIFt2ZW50b2xpbl07IGFjZXRhbWlub3BoZW4gMzI1IG1nIC8gb3h5Y29kb25lIGh5ZHJvY2hsb3JpZGUgNSBtZyBvcmFsIHRhYmxldDsgY2VmZGluaXI7IG5hcHJveGVuIHNvZGl1bSAyMjAgbWcgb3JhbCB0YWJsZXQ7IGJ1ZGVzb25pZGUgMC4yNSBtZy9tbCBpbmhhbGF0aW9uIHN1c3BlbnNpb247IGNpcHJvZmxveGFjaW4gNTAwIG1nIG9yYWwgdGFibGV0DQoNCiMgQXNzZXNzbWVudCBhbmQgUGxhbg0KDQoNCg0KIyMgUGxhbg0KDQo=" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:0e8d3b94-3b30-0f38-1b76-29a430c30965", + "resource": { + "resourceType": "DocumentReference", + "id": "0e8d3b94-3b30-0f38-1b76-29a430c30965", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:ad4ea853-b11b-261f-6f4d-5ab2f6bcb33d" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2021-12-25T23:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:a71a136b-1c13-32bf-93e3-1c6751c8c730" + } ], + "period": { + "start": "2021-12-25T23:41:58+01:00", + "end": "2021-12-25T23:56:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:0bc34be5-40e3-b565-2f86-a35034bae75e", + "resource": { + "resourceType": "Claim", + "id": "0bc34be5-40e3-b565-2f86-a35034bae75e", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2021-12-25T23:41:58+01:00", + "end": "2021-12-25T23:56:58+01:00" + }, + "created": "2021-12-25T23:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "encounter": [ { + "reference": "urn:uuid:a71a136b-1c13-32bf-93e3-1c6751c8c730" + } ] + } ], + "total": { + "value": 142.58, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:fd39d709-cff1-6ccc-400c-0a768b951085", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "fd39d709-cff1-6ccc-400c-0a768b951085", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "0bc34be5-40e3-b565-2f86-a35034bae75e" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2021-12-25T23:56:58+01:00", + "end": "2022-12-25T23:56:58+01:00" + }, + "created": "2021-12-25T23:56:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:0bc34be5-40e3-b565-2f86-a35034bae75e" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "servicedPeriod": { + "start": "2021-12-25T23:41:58+01:00", + "end": "2021-12-25T23:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:a71a136b-1c13-32bf-93e3-1c6751c8c730" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 142.58, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299", + "resource": { + "resourceType": "Encounter", + "id": "1d796608-df67-0943-f000-76cb473a7299", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "1d796608-df67-0943-f000-76cb473a7299" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:9d2ece86-2a18-8cce-ea6a-bcc917e96242", + "resource": { + "resourceType": "Condition", + "id": "9d2ece86-2a18-8cce-ea6a-bcc917e96242", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "onsetDateTime": "2022-09-04T09:22:22+01:00", + "abatementDateTime": "2023-09-10T09:36:54+01:00", + "recordedDate": "2022-09-04T09:22:22+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:9f207caa-f3d2-e264-ce73-56be905875c0", + "resource": { + "resourceType": "Condition", + "id": "9f207caa-f3d2-e264-ce73-56be905875c0", + "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": "706893006", + "display": "Victim of intimate partner abuse (finding)" + } ], + "text": "Victim of intimate partner abuse (finding)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "onsetDateTime": "2022-09-04T09:22:22+01:00", + "abatementDateTime": "2023-09-10T09:36:54+01:00", + "recordedDate": "2022-09-04T09:22:22+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:48078e6c-4269-645b-b46f-8f133d711c2d", + "resource": { + "resourceType": "Condition", + "id": "48078e6c-4269-645b-b46f-8f133d711c2d", + "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": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "onsetDateTime": "2022-09-04T10:35:26+01:00", + "abatementDateTime": "2022-09-18T11:15:19+01:00", + "recordedDate": "2022-09-04T10:35:26+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:48300ec1-d392-4e73-5db1-083f0147ce24", + "resource": { + "resourceType": "Observation", + "id": "48300ec1-d392-4e73-5db1-083f0147ce24", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "valueQuantity": { + "value": 168.8, + "unit": "cm", + "system": "http://unitsofmeasure.org", + "code": "cm" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:e2f79fab-b2a8-fe27-1cce-69fa1023a5c4", + "resource": { + "resourceType": "Observation", + "id": "e2f79fab-b2a8-fe27-1cce-69fa1023a5c4", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:a2b54b0d-5ab8-97a8-0677-f7d6043b151b", + "resource": { + "resourceType": "Observation", + "id": "a2b54b0d-5ab8-97a8-0677-f7d6043b151b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "valueQuantity": { + "value": 86.8, + "unit": "kg", + "system": "http://unitsofmeasure.org", + "code": "kg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:33f18940-8539-6a0a-2622-5a0661831b70", + "resource": { + "resourceType": "Observation", + "id": "33f18940-8539-6a0a-2622-5a0661831b70", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "valueQuantity": { + "value": 30.46, + "unit": "kg/m2", + "system": "http://unitsofmeasure.org", + "code": "kg/m2" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c7d20230-2431-2c47-15de-de84ae65b02f", + "resource": { + "resourceType": "Observation", + "id": "c7d20230-2431-2c47-15de-de84ae65b02f", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "8462-4", + "display": "Diastolic Blood Pressure" + } ], + "text": "Diastolic Blood Pressure" + }, + "valueQuantity": { + "value": 88, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "8480-6", + "display": "Systolic Blood Pressure" + } ], + "text": "Systolic Blood Pressure" + }, + "valueQuantity": { + "value": 123, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:be86d6ff-dcf9-ea5c-3741-759f1eab4176", + "resource": { + "resourceType": "Observation", + "id": "be86d6ff-dcf9-ea5c-3741-759f1eab4176", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "valueQuantity": { + "value": 93, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:9a96a4fe-03fa-bfab-5986-53bc5d53c5e2", + "resource": { + "resourceType": "Observation", + "id": "9a96a4fe-03fa-bfab-5986-53bc5d53c5e2", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "valueQuantity": { + "value": 14, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:dce82c7a-8de6-e94d-57fb-050f95f16452", + "resource": { + "resourceType": "Observation", + "id": "dce82c7a-8de6-e94d-57fb-050f95f16452", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "valueQuantity": { + "value": 179.15, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:f51368ee-c2cb-c9f3-1932-f4c9135ba5cb", + "resource": { + "resourceType": "Observation", + "id": "f51368ee-c2cb-c9f3-1932-f4c9135ba5cb", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "valueQuantity": { + "value": 109.29, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:bc2d467f-88ba-088d-4909-ec55fcabf5c2", + "resource": { + "resourceType": "Observation", + "id": "bc2d467f-88ba-088d-4909-ec55fcabf5c2", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "valueQuantity": { + "value": 102.41, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:8ac33c78-0bdc-e8d6-a494-4656907deabb", + "resource": { + "resourceType": "Observation", + "id": "8ac33c78-0bdc-e8d6-a494-4656907deabb", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "valueQuantity": { + "value": 54.88, + "unit": "mg/dL", + "system": "http://unitsofmeasure.org", + "code": "mg/dL" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:5fb4fda1-503b-728b-33fb-aafbc12d08f3", + "resource": { + "resourceType": "Observation", + "id": "5fb4fda1-503b-728b-33fb-aafbc12d08f3", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "8517006", + "display": "Ex-smoker (finding)" + } ], + "text": "Ex-smoker (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:a2fb469c-6787-83be-71cf-3784bc45b6f5", + "resource": { + "resourceType": "Observation", + "id": "a2fb469c-6787-83be-71cf-3784bc45b6f5", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T09:22:22+01:00", + "issued": "2022-09-04T09:22:22.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "76501-6", + "display": "Within the last year, have you been afraid of your partner or ex-partner?" + } ], + "text": "Within the last year, have you been afraid of your partner or ex-partner?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA33-6", + "display": "Yes" + } ], + "text": "Yes" + } + }, { + "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": "LA30125-1", + "display": "Food" + } ], + "text": "Food" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63586-2", + "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + } ], + "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + }, + "valueQuantity": { + "value": 60262, + "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": "627 Ullrich Dam Unit 88" + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93033-9", + "display": "Are you worried about losing your housing?" + } ], + "text": "Are you worried about losing your housing?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "71802-3", + "display": "Housing status" + } ], + "text": "Housing status" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30189-7", + "display": "I have housing" + } ], + "text": "I have housing" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63512-8", + "display": "How many people are living or staying at this address?" + } ], + "text": "How many people are living or staying at this address?" + }, + "valueQuantity": { + "value": 7, + "unit": "{#}", + "system": "http://unitsofmeasure.org", + "code": "{#}" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "54899-0", + "display": "Preferred language" + } ], + "text": "Preferred language" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA43-5", + "display": "English" + } ], + "text": "English" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93034-7", + "display": "Have you been discharged from the armed forces of the United States?" + } ], + "text": "Have you been discharged from the armed forces of the United States?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93035-4", + "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + } ], + "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "32624-9", + "display": "Race" + } ], + "text": "Race" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA4457-3", + "display": "White" + } ], + "text": "White" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "56051-6", + "display": "Do you consider yourself Hispanic/Latino?" + } ], + "text": "Do you consider yourself Hispanic/Latino?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:6c682b3b-3b1b-9189-9ed5-a07fc6d56161", + "resource": { + "resourceType": "Observation", + "id": "6c682b3b-3b1b-9189-9ed5-a07fc6d56161", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T09:58:17+01:00", + "issued": "2022-09-04T09:58:17.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:95404801-7a4c-775e-3c9a-f1092df67743", + "resource": { + "resourceType": "Observation", + "id": "95404801-7a4c-775e-3c9a-f1092df67743", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T10:35:26+01:00", + "issued": "2022-09-04T10:35:26.201+01:00", + "valueQuantity": { + "value": 0, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:dd162faa-c62e-438e-9a17-5ef2a6fc63c3", + "resource": { + "resourceType": "Procedure", + "id": "dd162faa-c62e-438e-9a17-5ef2a6fc63c3", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "performedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:0b637cb0-0eb6-9dc1-b9e2-98a96883045d", + "resource": { + "resourceType": "Procedure", + "id": "0b637cb0-0eb6-9dc1-b9e2-98a96883045d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "performedPeriod": { + "start": "2022-09-04T09:22:22+01:00", + "end": "2022-09-04T09:32:56+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:6dead661-ac0d-246a-1e51-a8647c20a7a5", + "resource": { + "resourceType": "Procedure", + "id": "6dead661-ac0d-246a-1e51-a8647c20a7a5", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "performedPeriod": { + "start": "2022-09-04T09:32:56+01:00", + "end": "2022-09-04T09:58:17+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:4ab6a005-d1b5-f3cf-7b5f-8f9899549b5e", + "resource": { + "resourceType": "Procedure", + "id": "4ab6a005-d1b5-f3cf-7b5f-8f9899549b5e", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "performedPeriod": { + "start": "2022-09-04T09:58:17+01:00", + "end": "2022-09-04T10:10:21+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:20a8aed3-68f7-eff9-45f9-cdfa77d8f4e4", + "resource": { + "resourceType": "Procedure", + "id": "20a8aed3-68f7-eff9-45f9-cdfa77d8f4e4", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "performedPeriod": { + "start": "2022-09-04T10:10:21+01:00", + "end": "2022-09-04T10:35:26+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:fb18257a-da00-d8bb-339c-c6ba74f82d70", + "resource": { + "resourceType": "Procedure", + "id": "fb18257a-da00-d8bb-339c-c6ba74f82d70", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "performedPeriod": { + "start": "2022-09-04T10:35:26+01:00", + "end": "2022-09-04T10:40:26+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:effca375-b825-522b-4e6f-0fa5b7f4558d", + "resource": { + "resourceType": "MedicationRequest", + "id": "effca375-b825-522b-4e6f-0fa5b7f4558d", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "authoredOn": "2022-09-04T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:22613f52-af93-8e7e-7317-b0dccc16807a", + "resource": { + "resourceType": "Claim", + "id": "22613f52-af93-8e7e-7317-b0dccc16807a", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "created": "2022-09-04T09:22:22+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:effca375-b825-522b-4e6f-0fa5b7f4558d" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "encounter": [ { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:0b43fa23-0102-459a-46c8-27e8adec4fd4", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "0b43fa23-0102-459a-46c8-27e8adec4fd4", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "22613f52-af93-8e7e-7317-b0dccc16807a" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2022-09-04T09:22:22+01:00", + "end": "2023-09-04T09:22:22+01:00" + }, + "created": "2022-09-04T09:22:22+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:22613f52-af93-8e7e-7317-b0dccc16807a" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:01b5594f-e4ef-a1df-c1c4-25f1f2d75c8e", + "resource": { + "resourceType": "MedicationRequest", + "id": "01b5594f-e4ef-a1df-c1c4-25f1f2d75c8e", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "authoredOn": "2022-09-04T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:137d9d32-ad1d-90d5-ef7a-286112a18bf6", + "resource": { + "resourceType": "Claim", + "id": "137d9d32-ad1d-90d5-ef7a-286112a18bf6", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "created": "2022-09-04T09:22:22+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:01b5594f-e4ef-a1df-c1c4-25f1f2d75c8e" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "encounter": [ { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:5e4cbea8-6664-1eff-b01e-9ac9d491864f", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "5e4cbea8-6664-1eff-b01e-9ac9d491864f", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "137d9d32-ad1d-90d5-ef7a-286112a18bf6" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2022-09-04T09:22:22+01:00", + "end": "2023-09-04T09:22:22+01:00" + }, + "created": "2022-09-04T09:22:22+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:137d9d32-ad1d-90d5-ef7a-286112a18bf6" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:c2e78f5e-6a3c-3885-0652-bcd8e6baf811", + "resource": { + "resourceType": "Immunization", + "id": "c2e78f5e-6a3c-3885-0652-bcd8e6baf811", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "occurrenceDateTime": "2022-09-04T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:5e5a316d-3fa9-c6a8-2d93-e9604bba23ba", + "resource": { + "resourceType": "DiagnosticReport", + "id": "5e5a316d-3fa9-c6a8-2d93-e9604bba23ba", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "performer": [ { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } ], + "result": [ { + "reference": "urn:uuid:dce82c7a-8de6-e94d-57fb-050f95f16452", + "display": "Cholesterol [Mass/volume] in Serum or Plasma" + }, { + "reference": "urn:uuid:f51368ee-c2cb-c9f3-1932-f4c9135ba5cb", + "display": "Triglycerides" + }, { + "reference": "urn:uuid:bc2d467f-88ba-088d-4909-ec55fcabf5c2", + "display": "Low Density Lipoprotein Cholesterol" + }, { + "reference": "urn:uuid:8ac33c78-0bdc-e8d6-a494-4656907deabb", + "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:586bbab9-9944-c985-4693-4c024a88754a", + "resource": { + "resourceType": "DiagnosticReport", + "id": "586bbab9-9944-c985-4693-4c024a88754a", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T09:58:17+01:00", + "issued": "2022-09-04T09:58:17.201+01:00", + "result": [ { + "reference": "urn:uuid:6c682b3b-3b1b-9189-9ed5-a07fc6d56161", + "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:91fa83b3-2aec-f240-e8c5-28f9bde4cd0a", + "resource": { + "resourceType": "DiagnosticReport", + "id": "91fa83b3-2aec-f240-e8c5-28f9bde4cd0a", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T10:35:26+01:00", + "issued": "2022-09-04T10:35:26.201+01:00", + "result": [ { + "reference": "urn:uuid:95404801-7a4c-775e-3c9a-f1092df67743", + "display": "Total score [DAST-10]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:2b41c046-9ea4-1b59-5fb8-c841682131df", + "resource": { + "resourceType": "DiagnosticReport", + "id": "2b41c046-9ea4-1b59-5fb8-c841682131df", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, + "effectiveDateTime": "2022-09-04T08:41:58+01:00", + "issued": "2022-09-04T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:e797a18b-8fed-e6aa-d04b-d32f482dbcf6", + "resource": { + "resourceType": "DocumentReference", + "id": "e797a18b-8fed-e6aa-d04b-d32f482dbcf6", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:2b41c046-9ea4-1b59-5fb8-c841682131df" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2022-09-04T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:1d796608-df67-0943-f000-76cb473a7299" + } ], + "period": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:4c3824de-b09e-5c3d-e78d-c02251998ce5", + "resource": { + "resourceType": "Claim", + "id": "4c3824de-b09e-5c3d-e78d-c02251998ce5", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "created": "2022-09-04T09:22:22+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:c2e78f5e-6a3c-3885-0652-bcd8e6baf811" + } + }, { + "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:9d2ece86-2a18-8cce-ea6a-bcc917e96242" + } + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:9f207caa-f3d2-e264-ce73-56be905875c0" + } + }, { + "sequence": 3, + "diagnosisReference": { + "reference": "urn:uuid:48078e6c-4269-645b-b46f-8f133d711c2d" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:dd162faa-c62e-438e-9a17-5ef2a6fc63c3" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:0b637cb0-0eb6-9dc1-b9e2-98a96883045d" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:6dead661-ac0d-246a-1e51-a8647c20a7a5" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:4ab6a005-d1b5-f3cf-7b5f-8f9899549b5e" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:20a8aed3-68f7-eff9-45f9-cdfa77d8f4e4" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:fb18257a-da00-d8bb-339c-c6ba74f82d70" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:1d796608-df67-0943-f000-76cb473a7299" + } ] + }, { + "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://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": 4, + "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": 5, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "160903007", + "display": "Full-time employment (finding)" + } ], + "text": "Full-time employment (finding)" + } + }, { + "sequence": 6, + "diagnosisSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "706893006", + "display": "Victim of intimate partner abuse (finding)" + } ], + "text": "Victim of intimate partner abuse (finding)" + } + }, { + "sequence": 7, + "procedureSequence": [ 2 ], + "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": [ 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, + "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": [ 4 ], + "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": [ 5 ], + "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" + } + }, { + "sequence": 13, + "diagnosisSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + } + }, { + "sequence": 14, + "procedureSequence": [ 6 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 778.78, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:60e568f7-e372-d1f0-34f9-dd6eebce5d4a", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "60e568f7-e372-d1f0-34f9-dd6eebce5d4a", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "4c3824de-b09e-5c3d-e78d-c02251998ce5" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2022-09-04T09:22:22+01:00", + "end": "2023-09-04T09:22:22+01:00" + }, + "created": "2022-09-04T09:22:22+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:4c3824de-b09e-5c3d-e78d-c02251998ce5" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:9d2ece86-2a18-8cce-ea6a-bcc917e96242" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:9f207caa-f3d2-e264-ce73-56be905875c0" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + }, { + "sequence": 3, + "diagnosisReference": { + "reference": "urn:uuid:48078e6c-4269-645b-b46f-8f133d711c2d" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + } ] + }, { + "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": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "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://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": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 4, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 5, + "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": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "sequence": 6, + "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": "706893006", + "display": "Victim of intimate partner abuse (finding)" + } ], + "text": "Victim of intimate partner abuse (finding)" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "sequence": 7, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "171207006", + "display": "Depression screening (procedure)" + } ], + "text": "Depression screening (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 9, + "informationSequence": [ 3 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "55757-9", + "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" + } ], + "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 10, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "428211000124100", + "display": "Assessment of substance use (procedure)" + } ], + "text": "Assessment of substance use (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 11, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "713106006", + "display": "Screening for drug abuse (procedure)" + } ], + "text": "Screening for drug abuse (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 12, + "informationSequence": [ 4 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "82666-9", + "display": "Drug Abuse Screening Test-10 [DAST-10]" + } ], + "text": "Drug Abuse Screening Test-10 [DAST-10]" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 13, + "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": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "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": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-04T08:41:58+01:00", + "end": "2022-09-04T09:22:22+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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" + } ] + } + } ] + } ], + "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": 2358.512, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98", + "resource": { + "resourceType": "Encounter", + "id": "32f9d6fe-8ec9-cc77-53b3-289e3f96ee98", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "66383009", + "display": "Gingivitis (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:50595b33-a59c-2396-2b3e-95ac383899d8", + "resource": { + "resourceType": "Procedure", + "id": "50595b33-a59c-2396-2b3e-95ac383899d8", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + }, + "performedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T09:02:46+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:2e9ad335-d555-2f28-2c4f-fb2ab5140b93", + "resource": { + "resourceType": "Procedure", + "id": "2e9ad335-d555-2f28-2c4f-fb2ab5140b93", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + }, + "performedPeriod": { + "start": "2022-09-18T09:02:46+01:00", + "end": "2022-09-18T09:47:47+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:baa3791d-8352-31fa-26ca-375e5dee2664", + "resource": { + "resourceType": "Procedure", + "id": "baa3791d-8352-31fa-26ca-375e5dee2664", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + }, + "performedPeriod": { + "start": "2022-09-18T09:47:47+01:00", + "end": "2022-09-18T09:58:48+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:fd7dc63f-672b-f5e8-fd6e-83e0425ac191", + "resource": { + "resourceType": "Procedure", + "id": "fd7dc63f-672b-f5e8-fd6e-83e0425ac191", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + }, + "performedPeriod": { + "start": "2022-09-18T09:58:48+01:00", + "end": "2022-09-18T10:21:00+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:1abd91b2-29f9-32e0-1852-1efc2fbcfab9", + "resource": { + "resourceType": "Procedure", + "id": "1abd91b2-29f9-32e0-1852-1efc2fbcfab9", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + }, + "performedPeriod": { + "start": "2022-09-18T10:21:00+01:00", + "end": "2022-09-18T11:15:19+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:3ef41f81-adbc-06dc-7737-70fa4859d111", + "resource": { + "resourceType": "Procedure", + "id": "3ef41f81-adbc-06dc-7737-70fa4859d111", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "68071007", + "display": "Dental fluoride treatment (procedure)" + } ], + "text": "Dental fluoride treatment (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + }, + "performedPeriod": { + "start": "2022-09-18T11:15:19+01:00", + "end": "2022-09-18T11:47:03+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:e89d8512-3a6d-39f4-ddbe-fe7466ac8995", + "resource": { + "resourceType": "Procedure", + "id": "e89d8512-3a6d-39f4-ddbe-fe7466ac8995", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + }, + "performedPeriod": { + "start": "2022-09-18T11:47:03+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:2a2553f3-43a6-93e7-282d-debe65f23cc4", + "resource": { + "resourceType": "SupplyDelivery", + "id": "2a2553f3-43a6-93e7-282d-debe65f23cc4", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + } + }, + "occurrenceDateTime": "2022-09-18T09:47:47+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:02370f86-bd94-8f4e-85e6-fee49f562845", + "resource": { + "resourceType": "SupplyDelivery", + "id": "02370f86-bd94-8f4e-85e6-fee49f562845", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + } + }, + "occurrenceDateTime": "2022-09-18T09:47:47+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:9a7cda6d-3748-3a8b-366e-d22ecf546504", + "resource": { + "resourceType": "SupplyDelivery", + "id": "9a7cda6d-3748-3a8b-366e-d22ecf546504", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + } + }, + "occurrenceDateTime": "2022-09-18T09:47:47+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:a8d7d8a5-521a-72f5-96a6-67865d8e235b", + "resource": { + "resourceType": "Medication", + "id": "a8d7d8a5-521a-72f5-96a6-67865d8e235b", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication" ] + }, + "code": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "1535362", + "display": "sodium fluoride 0.0272 MG/MG Oral Gel" + } ], + "text": "sodium fluoride 0.0272 MG/MG Oral Gel" + }, + "status": "active" + }, + "request": { + "method": "POST", + "url": "Medication" + } + }, { + "fullUrl": "urn:uuid:e1b1a7b6-88f0-d32f-bb3e-0a267d12634c", + "resource": { + "resourceType": "MedicationRequest", + "id": "e1b1a7b6-88f0-d32f-bb3e-0a267d12634c", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "intent": "order", + "category": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", + "code": "outpatient", + "display": "Outpatient" + } ], + "text": "Outpatient" + } ], + "medicationReference": { + "reference": "urn:uuid:a8d7d8a5-521a-72f5-96a6-67865d8e235b" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + }, + "authoredOn": "2022-09-18T11:15:19+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:beb7b3af-0f46-e854-105b-ef1309ac12e7", + "resource": { + "resourceType": "Claim", + "id": "beb7b3af-0f46-e854-105b-ef1309ac12e7", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "created": "2022-09-18T12:06:13+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:e1b1a7b6-88f0-d32f-bb3e-0a267d12634c" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "1535362", + "display": "sodium fluoride 0.0272 MG/MG Oral Gel" + } ], + "text": "sodium fluoride 0.0272 MG/MG Oral Gel" + }, + "encounter": [ { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:bbcd9f8a-4c57-f143-d549-132e049ace2f", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "bbcd9f8a-4c57-f143-d549-132e049ace2f", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "beb7b3af-0f46-e854-105b-ef1309ac12e7" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2022-09-18T12:06:13+01:00", + "end": "2023-09-18T12:06:13+01:00" + }, + "created": "2022-09-18T12:06:13+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:beb7b3af-0f46-e854-105b-ef1309ac12e7" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "1535362", + "display": "sodium fluoride 0.0272 MG/MG Oral Gel" + } ], + "text": "sodium fluoride 0.0272 MG/MG Oral Gel" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:cabfff68-407e-3d99-0644-2d370215f4d4", + "resource": { + "resourceType": "MedicationAdministration", + "id": "cabfff68-407e-3d99-0644-2d370215f4d4", + "status": "completed", + "medicationCodeableConcept": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "1535362", + "display": "sodium fluoride 0.0272 MG/MG Oral Gel" + } ], + "text": "sodium fluoride 0.0272 MG/MG Oral Gel" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "context": { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + }, + "effectiveDateTime": "2022-09-18T11:15:19+01:00", + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "MedicationAdministration" + } + }, { + "fullUrl": "urn:uuid:0f4b3cb1-754d-6846-1746-062e8bd39cbd", + "resource": { + "resourceType": "DiagnosticReport", + "id": "0f4b3cb1-754d-6846-1746-062e8bd39cbd", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + }, + "effectiveDateTime": "2022-09-18T08:41:58+01:00", + "issued": "2022-09-18T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:3f97ab33-c99b-5267-713b-63739fe73b1b", + "resource": { + "resourceType": "DocumentReference", + "id": "3f97ab33-c99b-5267-713b-63739fe73b1b", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:0f4b3cb1-754d-6846-1746-062e8bd39cbd" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2022-09-18T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + } ], + "period": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:afda0cd0-9487-c059-58e6-603e1746f10f", + "resource": { + "resourceType": "Claim", + "id": "afda0cd0-9487-c059-58e6-603e1746f10f", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "created": "2022-09-18T12:06:13+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "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" + } ] + } + }, { + "sequence": 3, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:50595b33-a59c-2396-2b3e-95ac383899d8" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:2e9ad335-d555-2f28-2c4f-fb2ab5140b93" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:baa3791d-8352-31fa-26ca-375e5dee2664" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:fd7dc63f-672b-f5e8-fd6e-83e0425ac191" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:1abd91b2-29f9-32e0-1852-1efc2fbcfab9" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:3ef41f81-adbc-06dc-7737-70fa4859d111" + } + }, { + "sequence": 7, + "procedureReference": { + "reference": "urn:uuid:e89d8512-3a6d-39f4-ddbe-fe7466ac8995" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185349003", + "display": "Encounter for check up (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + } ] + }, { + "sequence": 2, + "procedureSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 3, + "procedureSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 4, + "informationSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 5, + "informationSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 6, + "informationSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 7, + "procedureSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 8, + "procedureSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 9, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 10, + "procedureSequence": [ 6 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "68071007", + "display": "Dental fluoride treatment (procedure)" + } ], + "text": "Dental fluoride treatment (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 11, + "procedureSequence": [ 7 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 3105.35, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:2ca9f17a-772f-6115-dcb4-fbb4b2b38ee3", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "2ca9f17a-772f-6115-dcb4-fbb4b2b38ee3", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "afda0cd0-9487-c059-58e6-603e1746f10f" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2022-09-18T12:06:13+01:00", + "end": "2023-09-18T12:06:13+01:00" + }, + "created": "2022-09-18T12:06:13+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:afda0cd0-9487-c059-58e6-603e1746f10f" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + } ] + }, { + "sequence": 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": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "68071007", + "display": "Dental fluoride treatment (procedure)" + } ], + "text": "Dental fluoride treatment (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "servicedPeriod": { + "start": "2022-09-18T08:41:58+01:00", + "end": "2022-09-18T12:06:13+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 3105.35, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 2415.8399999999997, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc", + "resource": { + "resourceType": "Encounter", + "id": "4997925e-b079-9673-2ab8-eb964dff90dc", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "4997925e-b079-9673-2ab8-eb964dff90dc" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:afd4a19c-1200-bd88-2ac7-bb89cde26db7", + "resource": { + "resourceType": "Condition", + "id": "afd4a19c-1200-bd88-2ac7-bb89cde26db7", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "onsetDateTime": "2023-09-10T09:36:54+01:00", + "abatementDateTime": "2024-09-15T09:27:57+01:00", + "recordedDate": "2023-09-10T09:36:54+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:5c5c8993-db72-0bd2-2d0d-6604ce2e32aa", + "resource": { + "resourceType": "Condition", + "id": "5c5c8993-db72-0bd2-2d0d-6604ce2e32aa", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "onsetDateTime": "2023-09-10T09:36:54+01:00", + "abatementDateTime": "2024-09-15T09:27:57+01:00", + "recordedDate": "2023-09-10T09:36:54+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:595ca76c-8708-be0d-14d5-ca19b68e82e2", + "resource": { + "resourceType": "Condition", + "id": "595ca76c-8708-be0d-14d5-ca19b68e82e2", + "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": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "onsetDateTime": "2023-09-10T10:30:17+01:00", + "abatementDateTime": "2023-09-24T10:53:18+01:00", + "recordedDate": "2023-09-10T10:30:17+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:be472105-dbed-135f-25a6-756769244416", + "resource": { + "resourceType": "Observation", + "id": "be472105-dbed-135f-25a6-756769244416", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T08:41:58+01:00", + "issued": "2023-09-10T08:41:58.201+01:00", + "valueQuantity": { + "value": 168.8, + "unit": "cm", + "system": "http://unitsofmeasure.org", + "code": "cm" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:d4b0822c-f69c-e658-d018-2f67c50a9e51", + "resource": { + "resourceType": "Observation", + "id": "d4b0822c-f69c-e658-d018-2f67c50a9e51", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T08:41:58+01:00", + "issued": "2023-09-10T08:41:58.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:e8c81860-586c-58d3-4f62-9c685fb1f5a8", + "resource": { + "resourceType": "Observation", + "id": "e8c81860-586c-58d3-4f62-9c685fb1f5a8", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T08:41:58+01:00", + "issued": "2023-09-10T08:41:58.201+01:00", + "valueQuantity": { + "value": 86.8, + "unit": "kg", + "system": "http://unitsofmeasure.org", + "code": "kg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:40c002f8-d2a3-5791-d8af-bf7a858ab3b7", + "resource": { + "resourceType": "Observation", + "id": "40c002f8-d2a3-5791-d8af-bf7a858ab3b7", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T08:41:58+01:00", + "issued": "2023-09-10T08:41:58.201+01:00", + "valueQuantity": { + "value": 30.46, + "unit": "kg/m2", + "system": "http://unitsofmeasure.org", + "code": "kg/m2" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:473c5aed-e76a-ac3d-344a-c993145fef5d", + "resource": { + "resourceType": "Observation", + "id": "473c5aed-e76a-ac3d-344a-c993145fef5d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T08:41:58+01:00", + "issued": "2023-09-10T08:41:58.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "8462-4", + "display": "Diastolic Blood Pressure" + } ], + "text": "Diastolic Blood Pressure" + }, + "valueQuantity": { + "value": 85, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "8480-6", + "display": "Systolic Blood Pressure" + } ], + "text": "Systolic Blood Pressure" + }, + "valueQuantity": { + "value": 117, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:2ba887bc-9117-6238-0183-8182127f7e78", + "resource": { + "resourceType": "Observation", + "id": "2ba887bc-9117-6238-0183-8182127f7e78", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T08:41:58+01:00", + "issued": "2023-09-10T08:41:58.201+01:00", + "valueQuantity": { + "value": 66, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:9bf77185-3b80-1f51-b0df-327accddaecf", + "resource": { + "resourceType": "Observation", + "id": "9bf77185-3b80-1f51-b0df-327accddaecf", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T08:41:58+01:00", + "issued": "2023-09-10T08:41:58.201+01:00", + "valueQuantity": { + "value": 16, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:d0c861ff-d2b8-6aab-1221-3e4055f277d4", + "resource": { + "resourceType": "Observation", + "id": "d0c861ff-d2b8-6aab-1221-3e4055f277d4", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T08:41:58+01:00", + "issued": "2023-09-10T08:41:58.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "8517006", + "display": "Ex-smoker (finding)" + } ], + "text": "Ex-smoker (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:e1a28779-4469-0f2e-f7a4-a646b9327fec", + "resource": { + "resourceType": "Observation", + "id": "e1a28779-4469-0f2e-f7a4-a646b9327fec", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T09:36:54+01:00", + "issued": "2023-09-10T09:36:54.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "76501-6", + "display": "Within the last year, have you been afraid of your partner or ex-partner?" + } ], + "text": "Within the last year, have you been afraid of your partner or ex-partner?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93026-3", + "display": "Do you feel physically and emotionally safe where you currently live?" + } ], + "text": "Do you feel physically and emotionally safe where you currently live?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA33-6", + "display": "Yes" + } ], + "text": "Yes" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93027-1", + "display": "Are you a refugee?" + } ], + "text": "Are you a refugee?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93028-9", + "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + } ], + "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93038-8", + "display": "Stress level" + } ], + "text": "Stress level" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA13863-8", + "display": "A little bit" + } ], + "text": "A little bit" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93029-7", + "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + } ], + "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30131-9", + "display": "3 to 5 times a week" + } ], + "text": "3 to 5 times a week" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93030-5", + "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + } ], + "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93031-3", + "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + } ], + "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30125-1", + "display": "Food" + } ], + "text": "Food" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63586-2", + "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + } ], + "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + }, + "valueQuantity": { + "value": 60262, + "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": "627 Ullrich Dam Unit 88" + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93033-9", + "display": "Are you worried about losing your housing?" + } ], + "text": "Are you worried about losing your housing?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "71802-3", + "display": "Housing status" + } ], + "text": "Housing status" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30189-7", + "display": "I have housing" + } ], + "text": "I have housing" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63512-8", + "display": "How many people are living or staying at this address?" + } ], + "text": "How many people are living or staying at this address?" + }, + "valueQuantity": { + "value": 7, + "unit": "{#}", + "system": "http://unitsofmeasure.org", + "code": "{#}" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "54899-0", + "display": "Preferred language" + } ], + "text": "Preferred language" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA43-5", + "display": "English" + } ], + "text": "English" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93034-7", + "display": "Have you been discharged from the armed forces of the United States?" + } ], + "text": "Have you been discharged from the armed forces of the United States?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93035-4", + "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + } ], + "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "32624-9", + "display": "Race" + } ], + "text": "Race" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA4457-3", + "display": "White" + } ], + "text": "White" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "56051-6", + "display": "Do you consider yourself Hispanic/Latino?" + } ], + "text": "Do you consider yourself Hispanic/Latino?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:340c796d-c40c-974a-d402-37b40f9fc1fb", + "resource": { + "resourceType": "Observation", + "id": "340c796d-c40c-974a-d402-37b40f9fc1fb", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T09:52:54+01:00", + "issued": "2023-09-10T09:52:54.201+01:00", + "valueQuantity": { + "value": 3, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:b5f18a8f-e6da-d75a-d72b-a02e43a7dd37", + "resource": { + "resourceType": "Observation", + "id": "b5f18a8f-e6da-d75a-d72b-a02e43a7dd37", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T10:30:17+01:00", + "issued": "2023-09-10T10:30:17.201+01:00", + "valueQuantity": { + "value": 2, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:d2ccdd7b-7cbd-943c-3495-60266676be55", + "resource": { + "resourceType": "Procedure", + "id": "d2ccdd7b-7cbd-943c-3495-60266676be55", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "performedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:efe20f6e-c035-7bac-122f-21126357dee0", + "resource": { + "resourceType": "Procedure", + "id": "efe20f6e-c035-7bac-122f-21126357dee0", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "performedPeriod": { + "start": "2023-09-10T09:36:54+01:00", + "end": "2023-09-10T09:52:54+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:66538902-415f-e682-a636-a6cdfddc351e", + "resource": { + "resourceType": "Procedure", + "id": "66538902-415f-e682-a636-a6cdfddc351e", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "performedPeriod": { + "start": "2023-09-10T09:52:54+01:00", + "end": "2023-09-10T10:04:39+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:8fe1357d-eb14-3cde-6375-f4778dbf6ff8", + "resource": { + "resourceType": "Procedure", + "id": "8fe1357d-eb14-3cde-6375-f4778dbf6ff8", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "performedPeriod": { + "start": "2023-09-10T10:04:39+01:00", + "end": "2023-09-10T10:30:17+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:9c527f8a-f00b-5073-5eca-2a30ca8e31f5", + "resource": { + "resourceType": "Procedure", + "id": "9c527f8a-f00b-5073-5eca-2a30ca8e31f5", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "performedPeriod": { + "start": "2023-09-10T10:30:17+01:00", + "end": "2023-09-10T10:43:52+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:532b1050-2a92-bcfb-eb72-01c2f564a4af", + "resource": { + "resourceType": "MedicationRequest", + "id": "532b1050-2a92-bcfb-eb72-01c2f564a4af", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "authoredOn": "2023-09-10T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:9d41ee31-082e-1baf-d3af-e56e59a91177", + "resource": { + "resourceType": "Claim", + "id": "9d41ee31-082e-1baf-d3af-e56e59a91177", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "created": "2023-09-10T09:36:54+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:532b1050-2a92-bcfb-eb72-01c2f564a4af" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "encounter": [ { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:2bb3f511-7bb5-9b28-430e-34fbc0d2b8ea", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "2bb3f511-7bb5-9b28-430e-34fbc0d2b8ea", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "9d41ee31-082e-1baf-d3af-e56e59a91177" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2023-09-10T09:36:54+01:00", + "end": "2024-09-10T09:36:54+01:00" + }, + "created": "2023-09-10T09:36:54+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:9d41ee31-082e-1baf-d3af-e56e59a91177" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:033e1495-1d83-60cd-4fe2-01f5e1e69e60", + "resource": { + "resourceType": "MedicationRequest", + "id": "033e1495-1d83-60cd-4fe2-01f5e1e69e60", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "authoredOn": "2023-09-10T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:54664a8e-470a-5830-b5c4-2dff7855f473", + "resource": { + "resourceType": "Claim", + "id": "54664a8e-470a-5830-b5c4-2dff7855f473", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "created": "2023-09-10T09:36:54+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:033e1495-1d83-60cd-4fe2-01f5e1e69e60" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "encounter": [ { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:c9a8ad09-7465-c5ff-3a2e-83996ef70d47", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "c9a8ad09-7465-c5ff-3a2e-83996ef70d47", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "54664a8e-470a-5830-b5c4-2dff7855f473" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2023-09-10T09:36:54+01:00", + "end": "2024-09-10T09:36:54+01:00" + }, + "created": "2023-09-10T09:36:54+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:54664a8e-470a-5830-b5c4-2dff7855f473" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:4def79e2-0e65-7241-9b75-218971e4606a", + "resource": { + "resourceType": "Immunization", + "id": "4def79e2-0e65-7241-9b75-218971e4606a", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "occurrenceDateTime": "2023-09-10T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:da652474-4849-e19d-237c-e8b8b2427a8a", + "resource": { + "resourceType": "DiagnosticReport", + "id": "da652474-4849-e19d-237c-e8b8b2427a8a", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T09:52:54+01:00", + "issued": "2023-09-10T09:52:54.201+01:00", + "result": [ { + "reference": "urn:uuid:340c796d-c40c-974a-d402-37b40f9fc1fb", + "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:bab3b5a8-80d9-8dd4-c865-d234655ffe93", + "resource": { + "resourceType": "DiagnosticReport", + "id": "bab3b5a8-80d9-8dd4-c865-d234655ffe93", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T10:30:17+01:00", + "issued": "2023-09-10T10:30:17.201+01:00", + "result": [ { + "reference": "urn:uuid:b5f18a8f-e6da-d75a-d72b-a02e43a7dd37", + "display": "Total score [AUDIT-C]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:5d5b8ffb-b2ff-35e7-1f5a-425af8a0c305", + "resource": { + "resourceType": "DiagnosticReport", + "id": "5d5b8ffb-b2ff-35e7-1f5a-425af8a0c305", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, + "effectiveDateTime": "2023-09-10T08:41:58+01:00", + "issued": "2023-09-10T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:2f0e1d94-8a6d-4f47-3bf7-0ba480004974", + "resource": { + "resourceType": "DocumentReference", + "id": "2f0e1d94-8a6d-4f47-3bf7-0ba480004974", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:5d5b8ffb-b2ff-35e7-1f5a-425af8a0c305" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2023-09-10T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:4997925e-b079-9673-2ab8-eb964dff90dc" + } ], + "period": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:4c199769-8fd2-ad4d-0c3c-f5cb631e1fcc", + "resource": { + "resourceType": "Claim", + "id": "4c199769-8fd2-ad4d-0c3c-f5cb631e1fcc", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "created": "2023-09-10T09:36:54+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:4def79e2-0e65-7241-9b75-218971e4606a" + } + }, { + "sequence": 2, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + }, { + "sequence": 3, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:afd4a19c-1200-bd88-2ac7-bb89cde26db7" + } + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:5c5c8993-db72-0bd2-2d0d-6604ce2e32aa" + } + }, { + "sequence": 3, + "diagnosisReference": { + "reference": "urn:uuid:595ca76c-8708-be0d-14d5-ca19b68e82e2" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:d2ccdd7b-7cbd-943c-3495-60266676be55" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:efe20f6e-c035-7bac-122f-21126357dee0" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:66538902-415f-e682-a636-a6cdfddc351e" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:8fe1357d-eb14-3cde-6375-f4778dbf6ff8" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:9c527f8a-f00b-5073-5eca-2a30ca8e31f5" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:4997925e-b079-9673-2ab8-eb964dff90dc" + } ] + }, { + "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": "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": 4, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "741062008", + "display": "Not in labor force (finding)" + } ], + "text": "Not in labor force (finding)" + } + }, { + "sequence": 5, + "diagnosisSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "73595000", + "display": "Stress (finding)" + } ], + "text": "Stress (finding)" + } + }, { + "sequence": 6, + "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": 7, + "informationSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "69737-5", + "display": "Generalized anxiety disorder 7 item (GAD-7)" + } ], + "text": "Generalized anxiety disorder 7 item (GAD-7)" + }, + "net": { + "value": 74.58, + "currency": "USD" + } + }, { + "sequence": 8, + "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": 9, + "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": 10, + "informationSequence": [ 3 ], + "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" + } + }, { + "sequence": 11, + "diagnosisSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + } + }, { + "sequence": 12, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 704.20, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:8c3d4ddd-2ccb-3618-4e54-a81d17105336", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "8c3d4ddd-2ccb-3618-4e54-a81d17105336", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "4c199769-8fd2-ad4d-0c3c-f5cb631e1fcc" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2023-09-10T09:36:54+01:00", + "end": "2024-09-10T09:36:54+01:00" + }, + "created": "2023-09-10T09:36:54+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:4c199769-8fd2-ad4d-0c3c-f5cb631e1fcc" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:afd4a19c-1200-bd88-2ac7-bb89cde26db7" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:5c5c8993-db72-0bd2-2d0d-6604ce2e32aa" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + }, { + "sequence": 3, + "diagnosisReference": { + "reference": "urn:uuid:595ca76c-8708-be0d-14d5-ca19b68e82e2" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + } ] + }, { + "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": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "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": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": 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": "741062008", + "display": "Not in labor force (finding)" + } ], + "text": "Not in labor force (finding)" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "sequence": 5, + "diagnosisSequence": [ 2 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "73595000", + "display": "Stress (finding)" + } ], + "text": "Stress (finding)" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "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": "710841007", + "display": "Assessment of anxiety (procedure)" + } ], + "text": "Assessment of anxiety (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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, + "informationSequence": [ 2 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "69737-5", + "display": "Generalized anxiety disorder 7 item (GAD-7)" + } ], + "text": "Generalized anxiety disorder 7 item (GAD-7)" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 8, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "428211000124100", + "display": "Assessment of substance use (procedure)" + } ], + "text": "Assessment of substance use (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 9, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "763302001", + "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" + } ], + "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": [ 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": "72109-2", + "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" + } ], + "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 11, + "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": "66383009", + "display": "Gingivitis (disorder)" + } ], + "text": "Gingivitis (disorder)" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "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": "103697008", + "display": "Patient referral for dental care (procedure)" + } ], + "text": "Patient referral for dental care (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-10T08:41:58+01:00", + "end": "2023-09-10T09:36:54+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 704.20, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 1953.728, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f", + "resource": { + "resourceType": "Encounter", + "id": "d836e047-d035-76b5-c4bd-8439a6f1d90f", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "d836e047-d035-76b5-c4bd-8439a6f1d90f" + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "66383009", + "display": "Gingivitis (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:e8d113cd-1e04-28a6-9b87-1336442be47d", + "resource": { + "resourceType": "Procedure", + "id": "e8d113cd-1e04-28a6-9b87-1336442be47d", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "performedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T09:02:25+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:c63e550e-b53a-c477-c246-90cdbf29a7b6", + "resource": { + "resourceType": "Procedure", + "id": "c63e550e-b53a-c477-c246-90cdbf29a7b6", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "performedPeriod": { + "start": "2023-09-24T09:02:25+01:00", + "end": "2023-09-24T09:32:34+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:6c07196f-3a73-5a3b-ce2b-a22a205dd3a1", + "resource": { + "resourceType": "Procedure", + "id": "6c07196f-3a73-5a3b-ce2b-a22a205dd3a1", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "performedPeriod": { + "start": "2023-09-24T09:32:34+01:00", + "end": "2023-09-24T10:07:42+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:df2aa5bf-7cc7-88ed-4293-5db7b7238320", + "resource": { + "resourceType": "Procedure", + "id": "df2aa5bf-7cc7-88ed-4293-5db7b7238320", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "performedPeriod": { + "start": "2023-09-24T10:07:42+01:00", + "end": "2023-09-24T10:22:39+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:0529c8b2-3e54-fb66-cbe1-02fc12a45d9f", + "resource": { + "resourceType": "Procedure", + "id": "0529c8b2-3e54-fb66-cbe1-02fc12a45d9f", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "performedPeriod": { + "start": "2023-09-24T10:22:39+01:00", + "end": "2023-09-24T10:52:39+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:5e4661b8-e4f8-e74e-4e83-096cf1ecd121", + "resource": { + "resourceType": "Procedure", + "id": "5e4661b8-e4f8-e74e-4e83-096cf1ecd121", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "performedPeriod": { + "start": "2023-09-24T10:22:39+01:00", + "end": "2023-09-24T10:53:18+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:07cdb795-42f4-e724-b415-f077e51f8499", + "resource": { + "resourceType": "Procedure", + "id": "07cdb795-42f4-e724-b415-f077e51f8499", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "68071007", + "display": "Dental fluoride treatment (procedure)" + } ], + "text": "Dental fluoride treatment (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "performedPeriod": { + "start": "2023-09-24T10:53:18+01:00", + "end": "2023-09-24T11:25:43+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:eec23d0b-6b98-7426-7041-d20f32a89899", + "resource": { + "resourceType": "Procedure", + "id": "eec23d0b-6b98-7426-7041-d20f32a89899", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] + }, + "status": "completed", + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "performedPeriod": { + "start": "2023-09-24T11:25:43+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:f1ffef4a-25d8-7bc3-2677-c0e8c64dba11", + "resource": { + "resourceType": "Device", + "id": "f1ffef4a-25d8-7bc3-2677-c0e8c64dba11", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ] + }, + "udiCarrier": [ { + "deviceIdentifier": "20101747413106", + "carrierHRF": "(01)20101747413106(11)230903(17)480917(10)313730786236323(21)1454" + } ], + "status": "active", + "distinctIdentifier": "20101747413106", + "manufactureDate": "2023-09-03T10:22:39+01:00", + "expirationDate": "2048-09-17T10:22:39+01:00", + "lotNumber": "313730786236323", + "serialNumber": "1454", + "deviceName": [ { + "name": "Dental x-ray system (physical object)", + "type": "user-friendly-name" + } ], + "type": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + } + }, + "request": { + "method": "POST", + "url": "Device" + } + }, { + "fullUrl": "urn:uuid:98862ad7-c773-7e62-89c5-7ec8237cee54", + "resource": { + "resourceType": "SupplyDelivery", + "id": "98862ad7-c773-7e62-89c5-7ec8237cee54", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + } + }, + "occurrenceDateTime": "2023-09-24T09:32:34+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:e48a907d-1f9d-a7e8-98ac-4cecd1cb7ebf", + "resource": { + "resourceType": "SupplyDelivery", + "id": "e48a907d-1f9d-a7e8-98ac-4cecd1cb7ebf", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + } + }, + "occurrenceDateTime": "2023-09-24T09:32:34+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:6632411e-cacf-8273-c2ad-aca48daf7bdf", + "resource": { + "resourceType": "SupplyDelivery", + "id": "6632411e-cacf-8273-c2ad-aca48daf7bdf", + "status": "completed", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/supply-item-type", + "code": "device", + "display": "Device" + } ] + }, + "suppliedItem": { + "quantity": { + "value": 1 + }, + "itemCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + } + }, + "occurrenceDateTime": "2023-09-24T09:32:34+01:00" + }, + "request": { + "method": "POST", + "url": "SupplyDelivery" + } + }, { + "fullUrl": "urn:uuid:9513843b-3010-3312-fe01-94f6265827db", + "resource": { + "resourceType": "Medication", + "id": "9513843b-3010-3312-fe01-94f6265827db", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication" ] + }, + "code": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "1535362", + "display": "sodium fluoride 0.0272 MG/MG Oral Gel" + } ], + "text": "sodium fluoride 0.0272 MG/MG Oral Gel" + }, + "status": "active" + }, + "request": { + "method": "POST", + "url": "Medication" + } + }, { + "fullUrl": "urn:uuid:89fed791-d6f0-b340-45fc-bd8c31313dc2", + "resource": { + "resourceType": "MedicationRequest", + "id": "89fed791-d6f0-b340-45fc-bd8c31313dc2", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "intent": "order", + "category": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", + "code": "outpatient", + "display": "Outpatient" + } ], + "text": "Outpatient" + } ], + "medicationReference": { + "reference": "urn:uuid:9513843b-3010-3312-fe01-94f6265827db" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "authoredOn": "2023-09-24T10:53:18+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + }, + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:26f1ee35-33f8-485c-4665-3786afafade9", + "resource": { + "resourceType": "Claim", + "id": "26f1ee35-33f8-485c-4665-3786afafade9", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "created": "2023-09-24T11:36:06+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:89fed791-d6f0-b340-45fc-bd8c31313dc2" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "1535362", + "display": "sodium fluoride 0.0272 MG/MG Oral Gel" + } ], + "text": "sodium fluoride 0.0272 MG/MG Oral Gel" + }, + "encounter": [ { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:95f7650b-2d31-7cd2-fee5-75c62379719b", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "95f7650b-2d31-7cd2-fee5-75c62379719b", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "26f1ee35-33f8-485c-4665-3786afafade9" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2023-09-24T11:36:06+01:00", + "end": "2024-09-24T11:36:06+01:00" + }, + "created": "2023-09-24T11:36:06+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:26f1ee35-33f8-485c-4665-3786afafade9" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "1535362", + "display": "sodium fluoride 0.0272 MG/MG Oral Gel" + } ], + "text": "sodium fluoride 0.0272 MG/MG Oral Gel" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:fb66a78b-45f1-6dc6-3e52-80ab1915117f", + "resource": { + "resourceType": "MedicationAdministration", + "id": "fb66a78b-45f1-6dc6-3e52-80ab1915117f", + "status": "completed", + "medicationCodeableConcept": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "1535362", + "display": "sodium fluoride 0.0272 MG/MG Oral Gel" + } ], + "text": "sodium fluoride 0.0272 MG/MG Oral Gel" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "context": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "effectiveDateTime": "2023-09-24T10:53:18+01:00", + "reasonReference": [ { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4", + "display": "Gingivitis (disorder)" + } ] + }, + "request": { + "method": "POST", + "url": "MedicationAdministration" + } + }, { + "fullUrl": "urn:uuid:f40464ba-1092-836e-627e-39d34cd95b52", + "resource": { + "resourceType": "ImagingStudy", + "id": "f40464ba-1092-836e-627e-39d34cd95b52", + "identifier": [ { + "use": "official", + "system": "urn:ietf:rfc:3986", + "value": "urn:oid:1.2.840.99999999.34504424.1695547359201" + } ], + "status": "available", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "started": "2023-09-24T10:22:39+01:00", + "numberOfSeries": 1, + "numberOfInstances": 1, + "procedureCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + } ], + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "series": [ { + "uid": "1.2.840.99999999.1.64978394.1695547359201", + "number": 1, + "modality": { + "system": "http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html", + "code": "DX", + "display": "Digital Radiography" + }, + "numberOfInstances": 1, + "bodySite": { + "system": "http://snomed.info/sct", + "code": "700016008", + "display": "Structure of region of internal part of mouth (body structure)" + }, + "started": "2023-09-24T10:22:39+01:00", + "instance": [ { + "uid": "1.2.840.99999999.1.1.68443956.1695547359201", + "sopClass": { + "system": "urn:ietf:rfc:3986", + "code": "urn:oid:1.2.840.10008.5.1.4.1.1.1.3" + }, + "number": 1, + "title": "Digital Intra-Oral X-Ray Image" + } ] + } ] + }, + "request": { + "method": "POST", + "url": "ImagingStudy" + } + }, { + "fullUrl": "urn:uuid:3a058082-937f-6fd7-ccff-ad8f7c6d7fcc", + "resource": { + "resourceType": "DiagnosticReport", + "id": "3a058082-937f-6fd7-ccff-ad8f7c6d7fcc", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, + "effectiveDateTime": "2023-09-24T08:41:58+01:00", + "issued": "2023-09-24T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:049d0d3b-b97d-c5ff-751c-b9d38ae62946", + "resource": { + "resourceType": "DocumentReference", + "id": "049d0d3b-b97d-c5ff-751c-b9d38ae62946", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:3a058082-937f-6fd7-ccff-ad8f7c6d7fcc" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2023-09-24T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "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:d836e047-d035-76b5-c4bd-8439a6f1d90f" + } ], + "period": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:8efab614-b8dc-e732-cf0a-effa67b58b14", + "resource": { + "resourceType": "Claim", + "id": "8efab614-b8dc-e732-cf0a-effa67b58b14", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "created": "2023-09-24T11:36:06+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "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" + } ] + } + }, { + "sequence": 3, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + }, { + "sequence": 4, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:e8d113cd-1e04-28a6-9b87-1336442be47d" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:c63e550e-b53a-c477-c246-90cdbf29a7b6" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:6c07196f-3a73-5a3b-ce2b-a22a205dd3a1" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:df2aa5bf-7cc7-88ed-4293-5db7b7238320" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:0529c8b2-3e54-fb66-cbe1-02fc12a45d9f" + } + }, { + "sequence": 6, + "procedureReference": { + "reference": "urn:uuid:5e4661b8-e4f8-e74e-4e83-096cf1ecd121" + } + }, { + "sequence": 7, + "procedureReference": { + "reference": "urn:uuid:07cdb795-42f4-e724-b415-f077e51f8499" + } + }, { + "sequence": 8, + "procedureReference": { + "reference": "urn:uuid:eec23d0b-6b98-7426-7041-d20f32a89899" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "185349003", + "display": "Encounter for check up (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + } ] + }, { + "sequence": 2, + "procedureSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 3, + "procedureSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 4, + "informationSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 5, + "informationSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 6, + "informationSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 7, + "procedureSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 8, + "procedureSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 9, + "informationSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "net": { + "value": 0.00, + "currency": "USD" + } + }, { + "sequence": 10, + "procedureSequence": [ 5 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 11, + "procedureSequence": [ 6 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 12, + "procedureSequence": [ 7 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "68071007", + "display": "Dental fluoride treatment (procedure)" + } ], + "text": "Dental fluoride treatment (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 13, + "procedureSequence": [ 8 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + } ], + "total": { + "value": 3536.75, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:ffb8a004-53f6-3698-212e-8c1c00480875", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "ffb8a004-53f6-3698-212e-8c1c00480875", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "8efab614-b8dc-e732-cf0a-effa67b58b14" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2023-09-24T11:36:06+01:00", + "end": "2024-09-24T11:36:06+01:00" + }, + "created": "2023-09-24T11:36:06+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:8efab614-b8dc-e732-cf0a-effa67b58b14" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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 (procedure)" + } ], + "text": "Encounter for check up (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + } ] + }, { + "sequence": 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": "34043003", + "display": "Dental consultation and report (procedure)" + } ], + "text": "Dental consultation and report (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "225362009", + "display": "Dental care (regime/therapy)" + } ], + "text": "Dental care (regime/therapy)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": 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": "277183007", + "display": "Dental equipment (physical object)" + } ], + "text": "Dental equipment (physical object)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1230220004", + "display": "Conventional release periodontal gel (dose form)" + } ], + "text": "Conventional release periodontal gel (dose form)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "469020004", + "display": "Dental floss (physical object)" + } ], + "text": "Dental floss (physical object)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "1260009003", + "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "1260010008", + "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + } ], + "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": [ 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": "706298007", + "display": "Dental x-ray system (physical object)" + } ], + "text": "Dental x-ray system (physical object)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "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" + } ] + } + } ] + }, { + "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": "241046008", + "display": "Dental plain X-ray bitewing (procedure)" + } ], + "text": "Dental plain X-ray bitewing (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "274788003", + "display": "Examination of gingivae (procedure)" + } ], + "text": "Examination of gingivae (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "68071007", + "display": "Dental fluoride treatment (procedure)" + } ], + "text": "Dental fluoride treatment (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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": "243085009", + "display": "Oral health education (procedure)" + } ], + "text": "Oral health education (procedure)" + }, + "servicedPeriod": { + "start": "2023-09-24T08:41:58+01:00", + "end": "2023-09-24T11:36:06+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient 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" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 3536.75, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 2760.9599999999996, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:f0860fe5-1c93-2649-80b3-82287496584e", + "resource": { + "resourceType": "Encounter", + "id": "f0860fe5-1c93-2649-80b3-82287496584e", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "f0860fe5-1c93-2649-80b3-82287496584e" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2024-06-19T08:41:58+01:00", + "end": "2024-06-19T09:41:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } + } ], + "period": { + "start": "2024-06-19T08:41:58+01:00", + "end": "2024-06-19T09:41:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "384709000", + "display": "Sprain (morphologic abnormality)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:95495e5f-0855-af73-d37a-565e04bd89cf", + "resource": { + "resourceType": "Condition", + "id": "95495e5f-0855-af73-d37a-565e04bd89cf", + "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": "384709000", + "display": "Sprain (morphologic abnormality)" + } ], + "text": "Sprain (morphologic abnormality)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f0860fe5-1c93-2649-80b3-82287496584e" + }, + "onsetDateTime": "2024-06-19T08:41:58+01:00", + "abatementDateTime": "2024-07-18T08:41:58+01:00", + "recordedDate": "2024-06-19T08:41:58+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:9bc5c01c-18be-78e2-08e8-501dc6be99ce", + "resource": { + "resourceType": "Condition", + "id": "9bc5c01c-18be-78e2-08e8-501dc6be99ce", + "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": "70704007", + "display": "Sprain of wrist (disorder)" + } ], + "text": "Sprain of wrist (disorder)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f0860fe5-1c93-2649-80b3-82287496584e" + }, + "onsetDateTime": "2024-06-19T08:41:58+01:00", + "abatementDateTime": "2024-07-18T08:41:58+01:00", + "recordedDate": "2024-06-19T08:41:58+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:bf294b88-cbd0-1485-9558-3197a14a0b59", + "resource": { + "resourceType": "MedicationRequest", + "id": "bf294b88-cbd0-1485-9558-3197a14a0b59", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] + }, + "status": "completed", + "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": "310965", + "display": "Ibuprofen 200 MG Oral Tablet" + } ], + "text": "Ibuprofen 200 MG Oral Tablet" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f0860fe5-1c93-2649-80b3-82287496584e" + }, + "authoredOn": "2024-06-19T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + }, + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:740ac138-db90-ca85-2ee4-c0b3c78bc658", + "resource": { + "resourceType": "Claim", + "id": "740ac138-db90-ca85-2ee4-c0b3c78bc658", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2024-06-19T08:41:58+01:00", + "end": "2024-06-19T09:41:58+01:00" + }, + "created": "2024-06-19T09:41:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:bf294b88-cbd0-1485-9558-3197a14a0b59" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "310965", + "display": "Ibuprofen 200 MG Oral Tablet" + } ], + "text": "Ibuprofen 200 MG Oral Tablet" + }, + "encounter": [ { + "reference": "urn:uuid:f0860fe5-1c93-2649-80b3-82287496584e" + } ] + } ], + "total": { + "value": 256.37, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:801fcf1a-6d1d-6b57-0f00-daf518502de6", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "801fcf1a-6d1d-6b57-0f00-daf518502de6", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "740ac138-db90-ca85-2ee4-c0b3c78bc658" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2024-06-19T09:41:58+01:00", + "end": "2025-06-19T09:41:58+01:00" + }, + "created": "2024-06-19T09:41:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "claim": { + "reference": "urn:uuid:740ac138-db90-ca85-2ee4-c0b3c78bc658" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "310965", + "display": "Ibuprofen 200 MG Oral Tablet" + } ], + "text": "Ibuprofen 200 MG Oral Tablet" + }, + "servicedPeriod": { + "start": "2024-06-19T08:41:58+01:00", + "end": "2024-06-19T09:41:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:f0860fe5-1c93-2649-80b3-82287496584e" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 256.37, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:1d8a57cd-eb37-257a-590e-873898022fb4", + "resource": { + "resourceType": "CareTeam", + "id": "1d8a57cd-eb37-257a-590e-873898022fb4", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] + }, + "status": "inactive", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f0860fe5-1c93-2649-80b3-82287496584e" + }, + "period": { + "start": "2024-06-19T08:41:58+01:00", + "end": "2024-07-18T08:41:58+01:00" + }, + "participant": [ { + "role": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "116154003", + "display": "Patient" + } ], + "text": "Patient" + } ], + "member": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + } + }, { + "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|9999886895", + "display": "Dr. Damon455 Schultz619" + } + }, { + "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|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } ], + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "70704007", + "display": "Sprain of wrist (disorder)" + } ], + "text": "Sprain of wrist (disorder)" + } ], + "managingOrganization": [ { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } ] + }, + "request": { + "method": "POST", + "url": "CareTeam" + } + }, { + "fullUrl": "urn:uuid:7710f78c-be1e-364b-b615-c4048cd38c2c", + "resource": { + "resourceType": "CarePlan", + "id": "7710f78c-be1e-364b-b615-c4048cd38c2c", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] + }, + "text": { + "status": "generated", + "div": "
Care Plan for Physiotherapy care plan (record artifact).
Care plan is meant to treat Sprain of wrist (disorder).
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": "773513001", + "display": "Physiotherapy care plan (record artifact)" + } ], + "text": "Physiotherapy care plan (record artifact)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f0860fe5-1c93-2649-80b3-82287496584e" + }, + "period": { + "start": "2024-06-19T08:41:58+01:00", + "end": "2024-07-18T08:41:58+01:00" + }, + "careTeam": [ { + "reference": "urn:uuid:1d8a57cd-eb37-257a-590e-873898022fb4" + } ], + "addresses": [ { + "reference": "urn:uuid:9bc5c01c-18be-78e2-08e8-501dc6be99ce" + } ], + "activity": [ { + "detail": { + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "229586001", + "display": "Rest, ice, compression and elevation treatment program (regime/therapy)" + } ], + "text": "Rest, ice, compression and elevation treatment program (regime/therapy)" + }, + "reasonReference": [ { + "reference": "urn:uuid:9bc5c01c-18be-78e2-08e8-501dc6be99ce" + } ], + "status": "completed", + "location": { + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } + }, { + "detail": { + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "229070002", + "display": "Stretching exercises (regime/therapy)" + } ], + "text": "Stretching exercises (regime/therapy)" + }, + "reasonReference": [ { + "reference": "urn:uuid:9bc5c01c-18be-78e2-08e8-501dc6be99ce" + } ], + "status": "completed", + "location": { + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } + } ] + }, + "request": { + "method": "POST", + "url": "CarePlan" + } + }, { + "fullUrl": "urn:uuid:5b448a63-7323-2605-1d43-3cc2b8c4b323", + "resource": { + "resourceType": "DiagnosticReport", + "id": "5b448a63-7323-2605-1d43-3cc2b8c4b323", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:f0860fe5-1c93-2649-80b3-82287496584e" + }, + "effectiveDateTime": "2024-06-19T08:41:58+01:00", + "issued": "2024-06-19T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:4e8dbda8-7d40-8d48-5b76-abb872d38775", + "resource": { + "resourceType": "DocumentReference", + "id": "4e8dbda8-7d40-8d48-5b76-abb872d38775", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:5b448a63-7323-2605-1d43-3cc2b8c4b323" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2024-06-19T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "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:f0860fe5-1c93-2649-80b3-82287496584e" + } ], + "period": { + "start": "2024-06-19T08:41:58+01:00", + "end": "2024-06-19T09:41:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:109b6cd4-cab9-1d60-7e85-cb74d0fdae3e", + "resource": { + "resourceType": "Claim", + "id": "109b6cd4-cab9-1d60-7e85-cb74d0fdae3e", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "institutional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2024-06-19T08:41:58+01:00", + "end": "2024-06-19T09:41:58+01:00" + }, + "created": "2024-06-19T09:41:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:95495e5f-0855-af73-d37a-565e04bd89cf" + } + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:9bc5c01c-18be-78e2-08e8-501dc6be99ce" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:f0860fe5-1c93-2649-80b3-82287496584e" + } ] + }, { + "sequence": 2, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "384709000", + "display": "Sprain (morphologic abnormality)" + } ], + "text": "Sprain (morphologic abnormality)" + } + }, { + "sequence": 3, + "diagnosisSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "70704007", + "display": "Sprain of wrist (disorder)" + } ], + "text": "Sprain of wrist (disorder)" + } + } ], + "total": { + "value": 146.18, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:a29280c9-0221-5425-8fe8-1a2a4968c4ab", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "a29280c9-0221-5425-8fe8-1a2a4968c4ab", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "109b6cd4-cab9-1d60-7e85-cb74d0fdae3e" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2024-06-19T09:41:58+01:00", + "end": "2025-06-19T09:41:58+01:00" + }, + "created": "2024-06-19T09:41:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "claim": { + "reference": "urn:uuid:109b6cd4-cab9-1d60-7e85-cb74d0fdae3e" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:95495e5f-0855-af73-d37a-565e04bd89cf" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + }, { + "sequence": 2, + "diagnosisReference": { + "reference": "urn:uuid:9bc5c01c-18be-78e2-08e8-501dc6be99ce" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "2024-06-19T08:41:58+01:00", + "end": "2024-06-19T09:41:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:f0860fe5-1c93-2649-80b3-82287496584e" + } ] + }, { + "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": "384709000", + "display": "Sprain (morphologic abnormality)" + } ], + "text": "Sprain (morphologic abnormality)" + }, + "servicedPeriod": { + "start": "2024-06-19T08:41:58+01:00", + "end": "2024-06-19T09:41:58+01:00" + }, + "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": "70704007", + "display": "Sprain of wrist (disorder)" + } ], + "text": "Sprain of wrist (disorder)" + }, + "servicedPeriod": { + "start": "2024-06-19T08:41:58+01:00", + "end": "2024-06-19T09:41:58+01:00" + }, + "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:2493ba39-c798-7f09-5295-bb3da1e2b29b", + "resource": { + "resourceType": "Encounter", + "id": "2493ba39-c798-7f09-5295-bb3da1e2b29b", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "2493ba39-c798-7f09-5295-bb3da1e2b29b" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } + } ], + "period": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:54f91b59-1aa4-3d4f-371b-d389e900aa02", + "resource": { + "resourceType": "Condition", + "id": "54f91b59-1aa4-3d4f-371b-d389e900aa02", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] + }, + "clinicalStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", + "code": "active" + } ] + }, + "verificationStatus": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", + "code": "confirmed" + } ] + }, + "category": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/condition-category", + "code": "encounter-diagnosis", + "display": "Encounter Diagnosis" + } ] + } ], + "code": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "160903007", + "display": "Full-time employment (finding)" + } ], + "text": "Full-time employment (finding)" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "onsetDateTime": "2024-09-15T09:27:57+01:00", + "recordedDate": "2024-09-15T09:27:57+01:00" + }, + "request": { + "method": "POST", + "url": "Condition" + } + }, { + "fullUrl": "urn:uuid:02746a0d-75a1-1c89-67d0-aa31de43a0ee", + "resource": { + "resourceType": "Observation", + "id": "02746a0d-75a1-1c89-67d0-aa31de43a0ee", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T08:41:58+01:00", + "issued": "2024-09-15T08:41:58.201+01:00", + "valueQuantity": { + "value": 168.8, + "unit": "cm", + "system": "http://unitsofmeasure.org", + "code": "cm" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:18bec7f0-88ff-c3c5-65c5-b1120fbdfcd1", + "resource": { + "resourceType": "Observation", + "id": "18bec7f0-88ff-c3c5-65c5-b1120fbdfcd1", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T08:41:58+01:00", + "issued": "2024-09-15T08:41:58.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:eff82f55-0075-2183-5f5c-884d328803a5", + "resource": { + "resourceType": "Observation", + "id": "eff82f55-0075-2183-5f5c-884d328803a5", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T08:41:58+01:00", + "issued": "2024-09-15T08:41:58.201+01:00", + "valueQuantity": { + "value": 86.8, + "unit": "kg", + "system": "http://unitsofmeasure.org", + "code": "kg" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:cfebdfd7-99cc-ca40-d55d-1e677c0f7147", + "resource": { + "resourceType": "Observation", + "id": "cfebdfd7-99cc-ca40-d55d-1e677c0f7147", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T08:41:58+01:00", + "issued": "2024-09-15T08:41:58.201+01:00", + "valueQuantity": { + "value": 30.46, + "unit": "kg/m2", + "system": "http://unitsofmeasure.org", + "code": "kg/m2" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c14d40e2-95f2-9b03-391f-35eb45c092a5", + "resource": { + "resourceType": "Observation", + "id": "c14d40e2-95f2-9b03-391f-35eb45c092a5", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T08:41:58+01:00", + "issued": "2024-09-15T08:41:58.201+01:00", + "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": 108, + "unit": "mm[Hg]", + "system": "http://unitsofmeasure.org", + "code": "mm[Hg]" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:076c2f6b-4a21-5c65-af81-d599652575f6", + "resource": { + "resourceType": "Observation", + "id": "076c2f6b-4a21-5c65-af81-d599652575f6", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T08:41:58+01:00", + "issued": "2024-09-15T08:41:58.201+01:00", + "valueQuantity": { + "value": 66, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:2fd3aeb0-b852-fa3d-2404-8438ec593f3f", + "resource": { + "resourceType": "Observation", + "id": "2fd3aeb0-b852-fa3d-2404-8438ec593f3f", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T08:41:58+01:00", + "issued": "2024-09-15T08:41:58.201+01:00", + "valueQuantity": { + "value": 14, + "unit": "/min", + "system": "http://unitsofmeasure.org", + "code": "/min" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:c4e2e189-98ad-4bc9-d69d-1bf7a9691347", + "resource": { + "resourceType": "Observation", + "id": "c4e2e189-98ad-4bc9-d69d-1bf7a9691347", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T08:41:58+01:00", + "issued": "2024-09-15T08:41:58.201+01:00", + "valueCodeableConcept": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "8517006", + "display": "Ex-smoker (finding)" + } ], + "text": "Ex-smoker (finding)" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:8d57de31-426e-32b2-34b7-4e361a00890a", + "resource": { + "resourceType": "Observation", + "id": "8d57de31-426e-32b2-34b7-4e361a00890a", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T09:27:57+01:00", + "issued": "2024-09-15T09:27:57.201+01:00", + "component": [ { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "76501-6", + "display": "Within the last year, have you been afraid of your partner or ex-partner?" + } ], + "text": "Within the last year, have you been afraid of your partner or ex-partner?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93026-3", + "display": "Do you feel physically and emotionally safe where you currently live?" + } ], + "text": "Do you feel physically and emotionally safe where you currently live?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA33-6", + "display": "Yes" + } ], + "text": "Yes" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93027-1", + "display": "Are you a refugee?" + } ], + "text": "Are you a refugee?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93028-9", + "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + } ], + "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93038-8", + "display": "Stress level" + } ], + "text": "Stress level" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA6568-5", + "display": "Not at all" + } ], + "text": "Not at all" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93029-7", + "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + } ], + "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30132-7", + "display": "5 or more times a week" + } ], + "text": "5 or more times a week" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93030-5", + "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + } ], + "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93031-3", + "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + } ], + "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30125-1", + "display": "Food" + } ], + "text": "Food" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63586-2", + "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + } ], + "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" + }, + "valueQuantity": { + "value": 60262, + "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": "627 Ullrich Dam Unit 88" + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93033-9", + "display": "Are you worried about losing your housing?" + } ], + "text": "Are you worried about losing your housing?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "71802-3", + "display": "Housing status" + } ], + "text": "Housing status" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA30189-7", + "display": "I have housing" + } ], + "text": "I have housing" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "63512-8", + "display": "How many people are living or staying at this address?" + } ], + "text": "How many people are living or staying at this address?" + }, + "valueQuantity": { + "value": 7, + "unit": "{#}", + "system": "http://unitsofmeasure.org", + "code": "{#}" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "54899-0", + "display": "Preferred language" + } ], + "text": "Preferred language" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA43-5", + "display": "English" + } ], + "text": "English" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93034-7", + "display": "Have you been discharged from the armed forces of the United States?" + } ], + "text": "Have you been discharged from the armed forces of the United States?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "93035-4", + "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + } ], + "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "32624-9", + "display": "Race" + } ], + "text": "Race" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA4457-3", + "display": "White" + } ], + "text": "White" + } + }, { + "code": { + "coding": [ { + "system": "http://loinc.org", + "code": "56051-6", + "display": "Do you consider yourself Hispanic/Latino?" + } ], + "text": "Do you consider yourself Hispanic/Latino?" + }, + "valueCodeableConcept": { + "coding": [ { + "system": "http://loinc.org", + "code": "LA32-8", + "display": "No" + } ], + "text": "No" + } + } ] + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:d7279d30-a504-3092-fc6d-22b72be8a77b", + "resource": { + "resourceType": "Observation", + "id": "d7279d30-a504-3092-fc6d-22b72be8a77b", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T09:47:37+01:00", + "issued": "2024-09-15T09:47:37.201+01:00", + "valueQuantity": { + "value": 2, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:25ff72eb-3d57-450a-6c6a-af25491f6e8d", + "resource": { + "resourceType": "Observation", + "id": "25ff72eb-3d57-450a-6c6a-af25491f6e8d", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T10:29:26+01:00", + "issued": "2024-09-15T10:29:26.201+01:00", + "valueQuantity": { + "value": 1, + "unit": "{score}", + "system": "http://unitsofmeasure.org", + "code": "{score}" + } + }, + "request": { + "method": "POST", + "url": "Observation" + } + }, { + "fullUrl": "urn:uuid:82717ee8-1e79-d257-bb31-0ce4fc35a9b3", + "resource": { + "resourceType": "Procedure", + "id": "82717ee8-1e79-d257-bb31-0ce4fc35a9b3", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "performedPeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T08:56:58+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:c4706ef8-6aa7-decc-16e5-43b36b7d1bd5", + "resource": { + "resourceType": "Procedure", + "id": "c4706ef8-6aa7-decc-16e5-43b36b7d1bd5", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "performedPeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:ef3701e5-ce0b-d802-9374-bbd7f979ffcb", + "resource": { + "resourceType": "Procedure", + "id": "ef3701e5-ce0b-d802-9374-bbd7f979ffcb", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "performedPeriod": { + "start": "2024-09-15T09:27:57+01:00", + "end": "2024-09-15T09:47:37+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:330ebf10-d52e-8e9a-a920-bd7301f945d7", + "resource": { + "resourceType": "Procedure", + "id": "330ebf10-d52e-8e9a-a920-bd7301f945d7", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "performedPeriod": { + "start": "2024-09-15T09:47:37+01:00", + "end": "2024-09-15T10:02:18+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:27ac56ee-6623-6914-930e-3468f9cbd4e2", + "resource": { + "resourceType": "Procedure", + "id": "27ac56ee-6623-6914-930e-3468f9cbd4e2", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "performedPeriod": { + "start": "2024-09-15T10:02:18+01:00", + "end": "2024-09-15T10:29:26+01:00" + }, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Procedure" + } + }, { + "fullUrl": "urn:uuid:1961cc95-2c63-26f3-2aec-a8045e58158b", + "resource": { + "resourceType": "MedicationRequest", + "id": "1961cc95-2c63-26f3-2aec-a8045e58158b", + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "authoredOn": "2024-09-15T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:269ad745-21ba-1a38-9abe-94c4ba80b2d2", + "resource": { + "resourceType": "Claim", + "id": "269ad745-21ba-1a38-9abe-94c4ba80b2d2", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "created": "2024-09-15T09:27:57+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:1961cc95-2c63-26f3-2aec-a8045e58158b" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "encounter": [ { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:bf9b2139-a16e-91b9-633e-d97c9ba3bdaa", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "bf9b2139-a16e-91b9-633e-d97c9ba3bdaa", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "269ad745-21ba-1a38-9abe-94c4ba80b2d2" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2024-09-15T09:27:57+01:00", + "end": "2025-09-15T09:27:57+01:00" + }, + "created": "2024-09-15T09:27:57+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:269ad745-21ba-1a38-9abe-94c4ba80b2d2" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "859088", + "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + } ], + "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" + }, + "servicedPeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:49420666-077a-3605-f22a-f49579678218", + "resource": { + "resourceType": "MedicationRequest", + "id": "49420666-077a-3605-f22a-f49579678218", + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "authoredOn": "2024-09-15T08:41:58+01:00", + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "233678006", + "display": "Childhood asthma (disorder)" + } ], + "text": "Childhood asthma (disorder)" + } ], + "dosageInstruction": [ { + "sequence": 1, + "text": "Take as needed.", + "asNeededBoolean": true + } ] + }, + "request": { + "method": "POST", + "url": "MedicationRequest" + } + }, { + "fullUrl": "urn:uuid:ce23cf3c-b256-c728-359c-1ab8e7d27fc2", + "resource": { + "resourceType": "Claim", + "id": "ce23cf3c-b256-c728-359c-1ab8e7d27fc2", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "pharmacy" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "created": "2024-09-15T09:27:57+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "prescription": { + "reference": "urn:uuid:49420666-077a-3605-f22a-f49579678218" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://www.nlm.nih.gov/research/umls/rxnorm", + "code": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "encounter": [ { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + } ] + } ], + "total": { + "value": 129.94, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:bfa77c57-9db3-be88-9457-3ee62c94ca71", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "bfa77c57-9db3-be88-9457-3ee62c94ca71", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "ce23cf3c-b256-c728-359c-1ab8e7d27fc2" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2024-09-15T09:27:57+01:00", + "end": "2025-09-15T09:27:57+01:00" + }, + "created": "2024-09-15T09:27:57+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:ce23cf3c-b256-c728-359c-1ab8e7d27fc2" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "351109", + "display": "budesonide 0.25 MG/ML Inhalation Suspension" + } ], + "text": "budesonide 0.25 MG/ML Inhalation Suspension" + }, + "servicedPeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 129.94, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:fb95cc7a-af90-8eb6-d9bb-0611030d7033", + "resource": { + "resourceType": "Immunization", + "id": "fb95cc7a-af90-8eb6-d9bb-0611030d7033", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "occurrenceDateTime": "2024-09-15T08:41:58+01:00", + "primarySource": true, + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Immunization" + } + }, { + "fullUrl": "urn:uuid:26e8727a-d997-d56f-afac-d30ea34e03af", + "resource": { + "resourceType": "DiagnosticReport", + "id": "26e8727a-d997-d56f-afac-d30ea34e03af", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T09:47:37+01:00", + "issued": "2024-09-15T09:47:37.201+01:00", + "result": [ { + "reference": "urn:uuid:d7279d30-a504-3092-fc6d-22b72be8a77b", + "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:7cb28e81-8b0d-bede-7c2c-59f873e7b5c9", + "resource": { + "resourceType": "DiagnosticReport", + "id": "7cb28e81-8b0d-bede-7c2c-59f873e7b5c9", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T10:29:26+01:00", + "issued": "2024-09-15T10:29:26.201+01:00", + "result": [ { + "reference": "urn:uuid:25ff72eb-3d57-450a-6c6a-af25491f6e8d", + "display": "Total score [DAST-10]" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:c8563c68-9fe4-ce08-226f-0e44bfcff3fd", + "resource": { + "resourceType": "DiagnosticReport", + "id": "c8563c68-9fe4-ce08-226f-0e44bfcff3fd", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, + "effectiveDateTime": "2024-09-15T08:41:58+01:00", + "issued": "2024-09-15T08:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:45476136-0849-273c-9e77-0406d6d8083b", + "resource": { + "resourceType": "DocumentReference", + "id": "45476136-0849-273c-9e77-0406d6d8083b", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:c8563c68-9fe4-ce08-226f-0e44bfcff3fd" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2024-09-15T08:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190", + "display": "Dr. Bernardo699 Pagac496" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "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:2493ba39-c798-7f09-5295-bb3da1e2b29b" + } ], + "period": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:31b38482-5e7d-8535-1995-debf8c353ce0", + "resource": { + "resourceType": "Claim", + "id": "31b38482-5e7d-8535-1995-debf8c353ce0", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "created": "2024-09-15T09:27:57+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|2fbb592e-2154-3a4d-856e-467d7ba5bed7", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "supportingInfo": [ { + "sequence": 1, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + }, + "valueReference": { + "reference": "urn:uuid:fb95cc7a-af90-8eb6-d9bb-0611030d7033" + } + }, { + "sequence": 2, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + }, { + "sequence": 3, + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", + "code": "info" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:54f91b59-1aa4-3d4f-371b-d389e900aa02" + } + } ], + "procedure": [ { + "sequence": 1, + "procedureReference": { + "reference": "urn:uuid:82717ee8-1e79-d257-bb31-0ce4fc35a9b3" + } + }, { + "sequence": 2, + "procedureReference": { + "reference": "urn:uuid:c4706ef8-6aa7-decc-16e5-43b36b7d1bd5" + } + }, { + "sequence": 3, + "procedureReference": { + "reference": "urn:uuid:ef3701e5-ce0b-d802-9374-bbd7f979ffcb" + } + }, { + "sequence": 4, + "procedureReference": { + "reference": "urn:uuid:330ebf10-d52e-8e9a-a920-bd7301f945d7" + } + }, { + "sequence": 5, + "procedureReference": { + "reference": "urn:uuid:27ac56ee-6623-6914-930e-3468f9cbd4e2" + } + } ], + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "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:2493ba39-c798-7f09-5295-bb3da1e2b29b" + } ] + }, { + "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": 215.70, + "currency": "USD" + } + }, { + "sequence": 4, + "procedureSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 5, + "diagnosisSequence": [ 1 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "160903007", + "display": "Full-time employment (finding)" + } ], + "text": "Full-time employment (finding)" + } + }, { + "sequence": 6, + "procedureSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "710841007", + "display": "Assessment of anxiety (procedure)" + } ], + "text": "Assessment of anxiety (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 7, + "informationSequence": [ 2 ], + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "69737-5", + "display": "Generalized anxiety disorder 7 item (GAD-7)" + } ], + "text": "Generalized anxiety disorder 7 item (GAD-7)" + }, + "net": { + "value": 74.58, + "currency": "USD" + } + }, { + "sequence": 8, + "procedureSequence": [ 4 ], + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "428211000124100", + "display": "Assessment of substance use (procedure)" + } ], + "text": "Assessment of substance use (procedure)" + }, + "net": { + "value": 431.40, + "currency": "USD" + } + }, { + "sequence": 9, + "procedureSequence": [ 5 ], + "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": 10, + "informationSequence": [ 3 ], + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "82666-9", + "display": "Drug Abuse Screening Test-10 [DAST-10]" + } ], + "text": "Drug Abuse Screening Test-10 [DAST-10]" + }, + "net": { + "value": 74.58, + "currency": "USD" + } + } ], + "total": { + "value": 919.90, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:26d2c28d-cbd1-db6e-43f0-84a59d7b3af3", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "26d2c28d-cbd1-db6e-43f0-84a59d7b3af3", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "31b38482-5e7d-8535-1995-debf8c353ce0" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2024-09-15T09:27:57+01:00", + "end": "2025-09-15T09:27:57+01:00" + }, + "created": "2024-09-15T09:27:57+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|fd8b940f-d153-39d0-9445-313aa12f8a83", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:31b38482-5e7d-8535-1995-debf8c353ce0" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999972190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "diagnosis": [ { + "sequence": 1, + "diagnosisReference": { + "reference": "urn:uuid:54f91b59-1aa4-3d4f-371b-d389e900aa02" + }, + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", + "code": "principal" + } ] + } ] + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + } ] + }, { + "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": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "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": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 215.70, + "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": 43.14, + "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": 172.56, + "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": 215.70, + "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": 215.70, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 4, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "710824005", + "display": "Assessment of health and social care needs (procedure)" + } ], + "text": "Assessment of health and social care needs (procedure)" + }, + "servicedPeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 86.28, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 345.12, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 431.40, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 5, + "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": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + } + }, { + "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": "710841007", + "display": "Assessment of anxiety (procedure)" + } ], + "text": "Assessment of anxiety (procedure)" + }, + "servicedPeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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, + "informationSequence": [ 2 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "69737-5", + "display": "Generalized anxiety disorder 7 item (GAD-7)" + } ], + "text": "Generalized anxiety disorder 7 item (GAD-7)" + }, + "servicedPeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + }, { + "sequence": 8, + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "428211000124100", + "display": "Assessment of substance use (procedure)" + } ], + "text": "Assessment of substance use (procedure)" + }, + "servicedPeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": "713106006", + "display": "Screening for drug abuse (procedure)" + } ], + "text": "Screening for drug abuse (procedure)" + }, + "servicedPeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 431.40, + "currency": "USD" + }, + "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": [ 3 ], + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", + "code": "1", + "display": "Medical care" + } ] + }, + "productOrService": { + "coding": [ { + "system": "http://loinc.org", + "code": "82666-9", + "display": "Drug Abuse Screening Test-10 [DAST-10]" + } ], + "text": "Drug Abuse Screening Test-10 [DAST-10]" + }, + "servicedPeriod": { + "start": "2024-09-15T08:41:58+01:00", + "end": "2024-09-15T09:27:57+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "19", + "display": "Off Campus-Outpatient Hospital" + } ] + }, + "net": { + "value": 74.58, + "currency": "USD" + }, + "adjudication": [ { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", + "display": "Line Beneficiary Coinsurance Amount" + } ] + }, + "amount": { + "value": 14.916, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", + "display": "Line Provider Payment Amount" + } ] + }, + "amount": { + "value": 59.664, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", + "display": "Line Submitted Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", + "display": "Line Allowed Charge Amount" + } ] + }, + "amount": { + "value": 74.58, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", + "display": "Line Beneficiary Part B Deductible Amount" + } ] + }, + "amount": { + "value": 0, + "currency": "USD" + } + }, { + "category": { + "coding": [ { + "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", + "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", + "display": "Line Processing Indicator Code" + } ] + } + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 919.90, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 1781.168, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:9cfb1ad6-78e5-15a3-de1a-448eea6eb8c4", + "resource": { + "resourceType": "Encounter", + "id": "9cfb1ad6-78e5-15a3-de1a-448eea6eb8c4", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "9cfb1ad6-78e5-15a3-de1a-448eea6eb8c4" + } ], + "status": "finished", + "class": { + "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", + "code": "EMER" + }, + "type": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "183478001", + "display": "Emergency hospital admission for asthma (procedure)" + } ], + "text": "Emergency hospital admission for asthma (procedure)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2024-12-09T23:41:58+01:00", + "end": "2024-12-10T00:41:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } + } ], + "period": { + "start": "2024-12-09T23:41:58+01:00", + "end": "2024-12-10T00:41:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "195967001", + "display": "Asthma (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:ae8e5465-bb30-7163-bb77-4275b0c36b90", + "resource": { + "resourceType": "DiagnosticReport", + "id": "ae8e5465-bb30-7163-bb77-4275b0c36b90", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:9cfb1ad6-78e5-15a3-de1a-448eea6eb8c4" + }, + "effectiveDateTime": "2024-12-09T23:41:58+01:00", + "issued": "2024-12-09T23:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:ef189725-d888-f66c-86e9-ff891ff97619", + "resource": { + "resourceType": "DocumentReference", + "id": "ef189725-d888-f66c-86e9-ff891ff97619", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:ae8e5465-bb30-7163-bb77-4275b0c36b90" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2024-12-09T23:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895", + "display": "Dr. Damon455 Schultz619" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "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:9cfb1ad6-78e5-15a3-de1a-448eea6eb8c4" + } ], + "period": { + "start": "2024-12-09T23:41:58+01:00", + "end": "2024-12-10T00:41:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:15518f55-3a8a-e156-1d13-119e7d7c650e", + "resource": { + "resourceType": "Claim", + "id": "15518f55-3a8a-e156-1d13-119e7d7c650e", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "institutional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2024-12-09T23:41:58+01:00", + "end": "2024-12-10T00:41:58+01:00" + }, + "created": "2024-12-10T00:41:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|51759ecf-0948-3f61-b8fc-09dd8f2b90a1", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "183478001", + "display": "Emergency hospital admission for asthma (procedure)" + } ], + "text": "Emergency hospital admission for asthma (procedure)" + }, + "encounter": [ { + "reference": "urn:uuid:9cfb1ad6-78e5-15a3-de1a-448eea6eb8c4" + } ] + } ], + "total": { + "value": 146.18, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:5d117b93-93b5-8ed9-74fe-b43b70d2ac9b", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "5d117b93-93b5-8ed9-74fe-b43b70d2ac9b", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "15518f55-3a8a-e156-1d13-119e7d7c650e" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2024-12-10T00:41:58+01:00", + "end": "2025-12-10T00:41:58+01:00" + }, + "created": "2024-12-10T00:41:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|466f9fc2-a6a5-3481-9a39-c52a6cf371d2", + "display": "FAIRVIEW COMMONS NURSING & REHABILITATION CENTER" + }, + "claim": { + "reference": "urn:uuid:15518f55-3a8a-e156-1d13-119e7d7c650e" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999886895" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "183478001", + "display": "Emergency hospital admission for asthma (procedure)" + } ], + "text": "Emergency hospital admission for asthma (procedure)" + }, + "servicedPeriod": { + "start": "2024-12-09T23:41:58+01:00", + "end": "2024-12-10T00:41:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "20", + "display": "Urgent Care Facility" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:9cfb1ad6-78e5-15a3-de1a-448eea6eb8c4" + } ] + } ], + "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:1013438a-1648-794d-58a9-a6adb261e9c5", + "resource": { + "resourceType": "Encounter", + "id": "1013438a-1648-794d-58a9-a6adb261e9c5", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] + }, + "identifier": [ { + "use": "official", + "system": "https://github.com/synthetichealth/synthea", + "value": "1013438a-1648-794d-58a9-a6adb261e9c5" + } ], + "status": "finished", + "class": { + "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", + "code": "AMB" + }, + "type": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + } ], + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Mr. Herbert830 Tyron580 Rowe323" + }, + "participant": [ { + "type": [ { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", + "code": "PPRF", + "display": "primary performer" + } ], + "text": "primary performer" + } ], + "period": { + "start": "2024-12-11T19:41:58+01:00", + "end": "2024-12-11T19:56:58+01:00" + }, + "individual": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } + } ], + "period": { + "start": "2024-12-11T19:41:58+01:00", + "end": "2024-12-11T19:56:58+01:00" + }, + "reasonCode": [ { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "195967001", + "display": "Asthma (disorder)" + } ] + } ], + "location": [ { + "location": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + } + } ], + "serviceProvider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, + "request": { + "method": "POST", + "url": "Encounter" + } + }, { + "fullUrl": "urn:uuid:0ab4a7c8-2678-f5ca-bd13-ed69b396b7c8", + "resource": { + "resourceType": "DiagnosticReport", + "id": "0ab4a7c8-2678-f5ca-bd13-ed69b396b7c8", + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "encounter": { + "reference": "urn:uuid:1013438a-1648-794d-58a9-a6adb261e9c5" + }, + "effectiveDateTime": "2024-12-11T19:41:58+01:00", + "issued": "2024-12-11T19:41:58.201+01:00", + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "presentedForm": [ { + "contentType": "text/plain; charset=utf-8", + "data": "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" + } ] + }, + "request": { + "method": "POST", + "url": "DiagnosticReport" + } + }, { + "fullUrl": "urn:uuid:68122543-16ed-7687-5622-1ad6111a8370", + "resource": { + "resourceType": "DocumentReference", + "id": "68122543-16ed-7687-5622-1ad6111a8370", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] + }, + "identifier": [ { + "system": "urn:ietf:rfc:3986", + "value": "urn:uuid:0ab4a7c8-2678-f5ca-bd13-ed69b396b7c8" + } ], + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "date": "2024-12-11T19:41:58.201+01:00", + "author": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190", + "display": "Dr. Theodore876 Ankunding277" + } ], + "custodian": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "content": [ { + "attachment": { + "contentType": "text/plain; charset=utf-8", + "data": "DQoyMDI0LTEyLTExDQoNCiMgQ2hpZWYgQ29tcGxhaW50DQotIENoZXN0IFByZXNzdXJlDQoNCg0KIyBIaXN0b3J5IG9mIFByZXNlbnQgSWxsbmVzcw0KSGVyYmVydDgzMA0KIGlzIGEgNDQgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIGdpbmdpdmFsIGRpc2Vhc2UgKGRpc29yZGVyKSwgcGFydGlhbCB0aGlja25lc3MgYnVybiAoZGlzb3JkZXIpLCBzcHJhaW4gKG1vcnBob2xvZ2ljIGFibm9ybWFsaXR5KSwgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCB1bmVtcGxveWVkIChmaW5kaW5nKSwgbGVha2luZyBkZW50YWwgZmlsbGluZyAoZmluZGluZyksIHNwcmFpbiBvZiB3cmlzdCAoZGlzb3JkZXIpLCB2aWN0aW0gb2YgaW50aW1hdGUgcGFydG5lciBhYnVzZSAoZmluZGluZyksIGJ1cm4gaW5qdXJ5IChtb3JwaG9sb2dpYyBhYm5vcm1hbGl0eSksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgbm90IGluIGxhYm9yIGZvcmNlIChmaW5kaW5nKSwgdW5oZWFsdGh5IGFsY29ob2wgZHJpbmtpbmcgYmVoYXZpb3IgKGZpbmRpbmcpLCBmdWxsLXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIGFjdXRlIGluZmVjdGl2ZSBjeXN0aXRpcyAoZGlzb3JkZXIpLCBnaW5naXZpdGlzIChkaXNvcmRlciksIHN0cmVzcyAoZmluZGluZyksIHNvY2lhbCBpc29sYXRpb24gKGZpbmRpbmcpLg0KDQojIFNvY2lhbCBIaXN0b3J5DQpQYXRpZW50IGlzIG1hcnJpZWQuIFBhdGllbnQgcXVpdCBzbW9raW5nIGF0IGFnZSAxNi4NCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLg0KDQpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLg0KIFBhdGllbnQgaGFzIGNvbXBsZXRlZCBzb21lIGNvbGxlZ2UgY291cnNlcy4NClBhdGllbnQgY3VycmVudGx5IGhhcyBBbnRoZW0uDQoNCiMgQWxsZXJnaWVzDQpObyBLbm93biBBbGxlcmdpZXMuDQoNCiMgTWVkaWNhdGlvbnMNCm5kYTAyMDk4MyAyMDAgYWN0dWF0IGFsYnV0ZXJvbCAwLjA5IG1nL2FjdHVhdCBtZXRlcmVkIGRvc2UgaW5oYWxlciBbdmVudG9saW5dOyBhY2V0YW1pbm9waGVuIDMyNSBtZyAvIG94eWNvZG9uZSBoeWRyb2NobG9yaWRlIDUgbWcgb3JhbCB0YWJsZXQ7IGlidXByb2ZlbiAyMDAgbWcgb3JhbCB0YWJsZXQ7IGNlZmRpbmlyOyBuYXByb3hlbiBzb2RpdW0gMjIwIG1nIG9yYWwgdGFibGV0OyBidWRlc29uaWRlIDAuMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uOyBjaXByb2Zsb3hhY2luIDUwMCBtZyBvcmFsIHRhYmxldDsgc29kaXVtIGZsdW9yaWRlIDAuMDI3MiBtZy9tZyBvcmFsIGdlbA0KDQojIEFzc2Vzc21lbnQgYW5kIFBsYW4NCg0KDQoNCiMjIFBsYW4NCg0K" + }, + "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:1013438a-1648-794d-58a9-a6adb261e9c5" + } ], + "period": { + "start": "2024-12-11T19:41:58+01:00", + "end": "2024-12-11T19:56:58+01:00" + } + } + }, + "request": { + "method": "POST", + "url": "DocumentReference" + } + }, { + "fullUrl": "urn:uuid:1f397b27-62ee-30de-d1d8-bbbe52180109", + "resource": { + "resourceType": "Claim", + "id": "1f397b27-62ee-30de-d1d8-bbbe52180109", + "status": "active", + "type": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claim-type", + "code": "professional" + } ] + }, + "use": "claim", + "patient": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92", + "display": "Herbert830 Rowe323" + }, + "billablePeriod": { + "start": "2024-12-11T19:41:58+01:00", + "end": "2024-12-11T19:56:58+01:00" + }, + "created": "2024-12-11T19:56:58+01:00", + "provider": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + }, + "priority": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/processpriority", + "code": "normal" + } ] + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "insurance": [ { + "sequence": 1, + "focal": true, + "coverage": { + "display": "Anthem" + } + } ], + "item": [ { + "sequence": 1, + "productOrService": { + "coding": [ { + "system": "http://snomed.info/sct", + "code": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "encounter": [ { + "reference": "urn:uuid:1013438a-1648-794d-58a9-a6adb261e9c5" + } ] + } ], + "total": { + "value": 142.58, + "currency": "USD" + } + }, + "request": { + "method": "POST", + "url": "Claim" + } + }, { + "fullUrl": "urn:uuid:4765f502-af4a-df80-ffa8-f2bca6428323", + "resource": { + "resourceType": "ExplanationOfBenefit", + "id": "4765f502-af4a-df80-ffa8-f2bca6428323", + "contained": [ { + "resourceType": "ServiceRequest", + "id": "referral", + "status": "completed", + "intent": "order", + "subject": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "requester": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "performer": [ { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + } ] + }, { + "resourceType": "Coverage", + "id": "coverage", + "status": "active", + "type": { + "text": "Anthem" + }, + "beneficiary": { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "payor": [ { + "display": "Anthem" + } ] + } ], + "identifier": [ { + "system": "https://bluebutton.cms.gov/resources/variables/clm_id", + "value": "1f397b27-62ee-30de-d1d8-bbbe52180109" + }, { + "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:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, + "billablePeriod": { + "start": "2024-12-11T19:56:58+01:00", + "end": "2025-12-11T19:56:58+01:00" + }, + "created": "2024-12-11T19:56:58+01:00", + "insurer": { + "display": "Anthem" + }, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "referral": { + "reference": "#referral" + }, + "facility": { + "reference": "Location?identifier=https://github.com/synthetichealth/synthea|13b4306d-4328-3fdf-b2f1-88d2dbd4bc31", + "display": "FAIRVIEW HOSPITAL" + }, + "claim": { + "reference": "urn:uuid:1f397b27-62ee-30de-d1d8-bbbe52180109" + }, + "outcome": "complete", + "careTeam": [ { + "sequence": 1, + "provider": { + "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986190" + }, + "role": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", + "code": "primary", + "display": "Primary provider" + } ] + } + } ], + "insurance": [ { + "focal": true, + "coverage": { + "reference": "#coverage", + "display": "Anthem" + } + } ], + "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": "394701000", + "display": "Asthma follow-up (regime/therapy)" + } ], + "text": "Asthma follow-up (regime/therapy)" + }, + "servicedPeriod": { + "start": "2024-12-11T19:41:58+01:00", + "end": "2024-12-11T19:56:58+01:00" + }, + "locationCodeableConcept": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", + "code": "21", + "display": "Inpatient Hospital" + } ] + }, + "encounter": [ { + "reference": "urn:uuid:1013438a-1648-794d-58a9-a6adb261e9c5" + } ] + } ], + "total": [ { + "category": { + "coding": [ { + "system": "http://terminology.hl7.org/CodeSystem/adjudication", + "code": "submitted", + "display": "Submitted Amount" + } ], + "text": "Submitted Amount" + }, + "amount": { + "value": 142.58, + "currency": "USD" + } + } ], + "payment": { + "amount": { + "value": 0.0, + "currency": "USD" + } + } + }, + "request": { + "method": "POST", + "url": "ExplanationOfBenefit" + } + }, { + "fullUrl": "urn:uuid:613f46a6-ad9f-0851-04f7-8712177550f5", + "resource": { + "resourceType": "Provenance", + "id": "613f46a6-ad9f-0851-04f7-8712177550f5", + "meta": { + "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance" ] + }, + "target": [ { + "reference": "urn:uuid:56a52527-d782-5736-2951-2ee1dcfb6a92" + }, { + "reference": "urn:uuid:eec4c9ac-83b4-a4b9-3efb-d34f95eafc65" + }, { + "reference": "urn:uuid:8661f003-b6e9-fef1-3fa9-377437e7ff13" + }, { + "reference": "urn:uuid:0487631b-4dea-ad9b-867d-5dccf649867d" + }, { + "reference": "urn:uuid:b79ff204-0723-e17c-6fdf-c84fefd81320" + }, { + "reference": "urn:uuid:05b5c76b-b54d-ce6f-a742-e52db4002db4" + }, { + "reference": "urn:uuid:587e2055-a4ca-f06e-aa62-438a62c0a68f" + }, { + "reference": "urn:uuid:e5ffd87a-0845-d6bd-e200-1bec9ed4b7bf" + }, { + "reference": "urn:uuid:8dfb273f-2efc-9d92-602f-7717d96f41f7" + }, { + "reference": "urn:uuid:c536ec48-ffaa-f1a2-cb29-61d08ac73513" + }, { + "reference": "urn:uuid:c2cd1eee-71db-1a43-45bc-bd78486bb314" + }, { + "reference": "urn:uuid:a50f7d14-9eed-6c06-31ee-bc1d44887a33" + }, { + "reference": "urn:uuid:28715b7b-0738-cd90-c182-5276ee8bcb03" + }, { + "reference": "urn:uuid:c0c098b2-5fff-27e6-73e3-956838d3e4be" + }, { + "reference": "urn:uuid:682f6169-836d-0508-8464-3b6b5026589d" + }, { + "reference": "urn:uuid:1b65f4a1-45bc-d267-a6cd-3c11c6bbfa59" + }, { + "reference": "urn:uuid:10612a98-c7d6-d133-def0-0b9821067403" + }, { + "reference": "urn:uuid:6f613325-67db-7d35-ec77-b959dee377fe" + }, { + "reference": "urn:uuid:08c80e32-1ffd-bc81-db4b-a497735c8018" + }, { + "reference": "urn:uuid:ab61f518-0b8a-353f-54a9-3c888c895ca3" + }, { + "reference": "urn:uuid:0b121219-cbfd-f536-8232-1a33c5e3ea58" + }, { + "reference": "urn:uuid:93ca7c88-5ce2-cb5d-98d4-b6c3e0edf373" + }, { + "reference": "urn:uuid:b04268c4-120e-3963-8f3e-d22bea9178a2" + }, { + "reference": "urn:uuid:88843827-4b86-e957-1765-37807b29ba1e" + }, { + "reference": "urn:uuid:0ee528f3-3c9b-3115-256b-5d6a4495fa92" + }, { + "reference": "urn:uuid:7fd0436e-8f09-9730-57a4-0517b0e639c4" + }, { + "reference": "urn:uuid:c01dd19a-66d1-fb67-d622-dbd4a256068f" + }, { + "reference": "urn:uuid:2ec96e33-a527-4e10-6e92-082f99f653e9" + }, { + "reference": "urn:uuid:bb88e2de-aaa8-81fa-65bc-aaac5d9085cb" + }, { + "reference": "urn:uuid:4407160c-bc96-4f59-266a-1b9b741f7b0f" + }, { + "reference": "urn:uuid:61b12e74-fdf1-a64f-0569-6f96dd4553f3" + }, { + "reference": "urn:uuid:5cf021a1-6e2f-9fcf-00a8-6177ba185401" + }, { + "reference": "urn:uuid:b2e52643-5d80-291f-f886-b3611f7edb7e" + }, { + "reference": "urn:uuid:e7ababff-5e9a-b815-8392-f1b5c0d77300" + }, { + "reference": "urn:uuid:cfe48f43-a003-9b3b-79bb-61157c242c2b" + }, { + "reference": "urn:uuid:7b34cd19-6045-aae8-1f0d-1f34a6bb5dff" + }, { + "reference": "urn:uuid:9d9a5619-1f27-75c0-0508-97197f054620" + }, { + "reference": "urn:uuid:a294bac2-021d-d293-4f2c-8c2a65654313" + }, { + "reference": "urn:uuid:d7480f50-0241-dd79-12cc-0cb4c0cd2094" + }, { + "reference": "urn:uuid:7a4b8673-b4bb-3cbb-f01b-38d92cdcd609" + }, { + "reference": "urn:uuid:aa5500d4-7691-bb63-215d-2f98446dcfd8" + }, { + "reference": "urn:uuid:a5dd61b7-7615-95bf-88b8-da5f4174c495" + }, { + "reference": "urn:uuid:ce15a65b-9636-32ad-d0ed-d58f8ba61ba3" + }, { + "reference": "urn:uuid:26cc320d-0b70-e9f6-b3e9-f40bbdd02f97" + }, { + "reference": "urn:uuid:f8fee68b-0724-0148-f32b-f373f533f6db" + }, { + "reference": "urn:uuid:e8e6a336-6adb-c63e-60ea-edc61f89cbe9" + }, { + "reference": "urn:uuid:53f81133-82f6-ab24-cb00-43b29c7cbf98" + }, { + "reference": "urn:uuid:9fa60ac9-aabd-9d66-fe36-2b2d090ef64f" + }, { + "reference": "urn:uuid:b0564bec-da35-247c-2f48-9487964d7595" + }, { + "reference": "urn:uuid:69f56969-128d-c798-807b-9de01a889115" + }, { + "reference": "urn:uuid:19f28a0c-8190-54fa-f03e-72c0b3340d39" + }, { + "reference": "urn:uuid:76fbe70b-92c3-e6ad-96bb-ab281e7a92ab" + }, { + "reference": "urn:uuid:9ceb7812-bf49-5a16-a29c-98cb111b3637" + }, { + "reference": "urn:uuid:66fb03e2-9520-3de8-62ff-f595a99025d6" + }, { + "reference": "urn:uuid:8ebeda02-892d-0b31-228c-9e88732e84be" + }, { + "reference": "urn:uuid:c8f6bae3-b6ed-3d99-047a-b848757880b4" + }, { + "reference": "urn:uuid:c8573c68-d18c-f89a-2270-0e44f1781e8f" + }, { + "reference": "urn:uuid:64bebb44-eb9e-376e-f91f-b3afa1a8da24" + }, { + "reference": "urn:uuid:6fbe882d-713e-f36f-ef61-1ebc52482e35" + }, { + "reference": "urn:uuid:5fa53a15-9594-d0f5-fd81-3fd9070015f0" + }, { + "reference": "urn:uuid:5e4b7fc0-877c-cc03-3ab7-3ffc1d4b7bd2" + }, { + "reference": "urn:uuid:a56cedd4-6ef8-3872-fe4d-17607a2acc8a" + }, { + "reference": "urn:uuid:aba8e0b9-67d0-150c-f74f-74b82dd3ea68" + }, { + "reference": "urn:uuid:740319c3-13ea-9fe2-b059-71ec7cd8b07b" + }, { + "reference": "urn:uuid:4d2b0e1b-5cfb-e667-a4d9-edb0fe00d991" + }, { + "reference": "urn:uuid:9c34d79e-d752-0955-1c69-70de3eb34f64" + }, { + "reference": "urn:uuid:9dafe68a-e0ea-6663-f408-0ff3cefaff9f" + }, { + "reference": "urn:uuid:999b76b8-7d42-7d6c-fe5a-01fb977e0169" + }, { + "reference": "urn:uuid:9aadc8a7-bf14-2e40-76cd-b3cdb36e4712" + }, { + "reference": "urn:uuid:05d12024-c0a1-f927-6c9f-602804588308" + }, { + "reference": "urn:uuid:aae0d9e8-2a65-e17d-6323-3ed983c68521" + }, { + "reference": "urn:uuid:f35b493b-59d0-3544-b183-67869056e748" + }, { + "reference": "urn:uuid:109b07cb-c8f5-c172-b413-6fd2729a8211" + }, { + "reference": "urn:uuid:bf38b04b-70db-f887-acbb-187fdb365cf4" + }, { + "reference": "urn:uuid:5f01c036-7761-9d58-e5b7-1370a63d540d" + }, { + "reference": "urn:uuid:eb66d771-0209-0027-06c4-a34e65aee9b7" + }, { + "reference": "urn:uuid:63275508-8e01-febc-c8bf-79494f501b88" + }, { + "reference": "urn:uuid:0cd46938-c34b-4789-1190-3153f5cfc51b" + }, { + "reference": "urn:uuid:416ac67f-85d4-996d-c846-43721ec9bae1" + }, { + "reference": "urn:uuid:c98dbf91-d694-d15b-55ee-9109a4372261" + }, { + "reference": "urn:uuid:19dbb124-019f-5cd3-a49f-e4bd15c8eb25" + }, { + "reference": "urn:uuid:382edf2c-adb9-08ea-2bfd-40df2dc11b5d" + }, { + "reference": "urn:uuid:9be33759-efe6-41f8-5337-1f1450d462d5" + }, { + "reference": "urn:uuid:bb82a232-eb21-918c-dbb6-395dbe05c7d8" + }, { + "reference": "urn:uuid:ea7bab83-dcfd-918a-987e-f038af0e1c67" + }, { + "reference": "urn:uuid:905c3dd0-3cd7-6e17-5c24-c4647bb9e9b2" + }, { + "reference": "urn:uuid:7da4b763-9225-abe3-da8a-d10799d6c250" + }, { + "reference": "urn:uuid:807a6751-234d-976c-8a08-62ed2f161fb0" + }, { + "reference": "urn:uuid:f479f826-f893-1abf-d154-cb00406e9feb" + }, { + "reference": "urn:uuid:47d5c34b-9964-431a-e0b7-b52c7ffc313a" + }, { + "reference": "urn:uuid:e1130c6b-3a01-2fde-1ecd-e7564f473dff" + }, { + "reference": "urn:uuid:7a6a1f42-f967-6be0-5131-642b544cc9bb" + }, { + "reference": "urn:uuid:2dcb11e8-829f-9758-2ff4-7ad6933c8efa" + }, { + "reference": "urn:uuid:f3c43f0c-1fe9-489b-49dc-0b63c8929261" + }, { + "reference": "urn:uuid:2b64e5e1-a663-1acd-651f-931d68f048a2" + }, { + "reference": "urn:uuid:3997996a-6e1b-1048-4a34-910c70447936" + }, { + "reference": "urn:uuid:161a7afd-91e4-fa55-9b7d-e35f10d3e821" + }, { + "reference": "urn:uuid:80f6f62f-6b5c-37bd-f838-8aed8bb9301c" + }, { + "reference": "urn:uuid:fcc70716-6056-3da5-4897-310bcbeb6891" + }, { + "reference": "urn:uuid:33062a82-938c-7023-c600-578f7c7a8018" + }, { + "reference": "urn:uuid:501ded03-becd-c5ff-c09d-999b90362946" + }, { + "reference": "urn:uuid:6833d919-dea6-91bb-29d1-7dd2e8b4479c" + }, { + "reference": "urn:uuid:9e9b063e-8f43-fb63-15a3-54ba60450fd8" + }, { + "reference": "urn:uuid:7a729d90-ea1b-3900-2f45-0951ed82c29d" + }, { + "reference": "urn:uuid:4d136b62-9498-5c0c-e00d-986f7d866c01" + }, { + "reference": "urn:uuid:557db9d4-28d4-c204-c5fd-666bfa3d254b" + }, { + "reference": "urn:uuid:985af010-a6ff-4d67-bd61-35effdc26dd4" + }, { + "reference": "urn:uuid:e97a7cb9-3635-1472-65f4-b6f4ba5c545e" + }, { + "reference": "urn:uuid:24eae8db-7b14-53e3-fb1f-7b830e6d8b00" + }, { + "reference": "urn:uuid:31feafd9-3647-055c-0657-29cc82a8e1d8" + }, { + "reference": "urn:uuid:7b571ec6-fa1a-095b-166f-5aa7c29f8a82" + }, { + "reference": "urn:uuid:be71ed5b-5b24-403b-63f3-b1753f1e23c2" + }, { + "reference": "urn:uuid:216313c3-8c01-e9ce-e20a-f0c9761a6414" + }, { + "reference": "urn:uuid:23ce0beb-df65-ed01-7252-e00df3da6409" + }, { + "reference": "urn:uuid:568cb55b-b8b8-5df5-dc2a-bbe9925cc2a1" + }, { + "reference": "urn:uuid:c8d73ac6-092c-831e-e881-9699f51cf433" + }, { + "reference": "urn:uuid:8d0d4613-7724-fcba-cf2e-8d5ae7a9e507" + }, { + "reference": "urn:uuid:699d7ec0-3ef6-e032-910d-b8a1a6e6cf8f" + }, { + "reference": "urn:uuid:299b83a1-f578-72d2-3a66-bb0fc585bf1b" + }, { + "reference": "urn:uuid:c73c667d-4b83-2606-8950-07b254084324" + }, { + "reference": "urn:uuid:bf3c5fe7-3f65-c4eb-0dc1-340953da3bf4" + }, { + "reference": "urn:uuid:d9c67c15-2281-fd25-a022-49cbcb395972" + }, { + "reference": "urn:uuid:27e4881c-73f1-8594-cab5-56ab54f0dec3" + }, { + "reference": "urn:uuid:b8a35a16-bf25-b446-b36c-d72d455a2b4e" + }, { + "reference": "urn:uuid:95a93ad6-91c5-ee36-2ade-7d569b6f9e44" + }, { + "reference": "urn:uuid:4e6a6bac-3694-cb94-ef9f-743153b28da7" + }, { + "reference": "urn:uuid:96e52485-3069-2658-f7ed-458b0ef5fffd" + }, { + "reference": "urn:uuid:b6528239-3e4d-401c-9bb9-9616a083bd27" + }, { + "reference": "urn:uuid:48b5e9b0-bd78-a207-701e-781669b7c531" + }, { + "reference": "urn:uuid:1cf7f9ec-0432-75df-496a-bb0235eeacc0" + }, { + "reference": "urn:uuid:1ada5364-a0b3-da96-c9e2-56e658f83736" + }, { + "reference": "urn:uuid:20179134-7431-ec82-6b55-f74b9490db46" + }, { + "reference": "urn:uuid:330be0c9-26f1-dc94-5a34-f6c116719e77" + }, { + "reference": "urn:uuid:56f683ed-da22-9ab6-171d-aabfd01af7bb" + }, { + "reference": "urn:uuid:ad942d36-4587-8fc2-4430-8eeacbc2efae" + }, { + "reference": "urn:uuid:f8cc502d-d0e2-7035-eee8-a94064ab8b0f" + }, { + "reference": "urn:uuid:6ec7335a-cee8-d9d1-fb0a-45824d09e3c0" + }, { + "reference": "urn:uuid:aacbc599-9bf7-f65a-30ce-84974b8e8c06" + }, { + "reference": "urn:uuid:9ad81788-b966-9546-3ce7-b5f38fefca77" + }, { + "reference": "urn:uuid:b5da1e37-8c64-bc70-a119-ac44348a06f5" + }, { + "reference": "urn:uuid:325345e3-d060-4c97-0c76-600f4577824e" + }, { + "reference": "urn:uuid:17492639-78a5-a7c6-5cea-b3573aa45a25" + }, { + "reference": "urn:uuid:69aba269-7f0b-6c3e-5f3e-9c968bf45a4e" + }, { + "reference": "urn:uuid:a4a3dad3-80e5-6755-f9b5-66ddf581fae5" + }, { + "reference": "urn:uuid:36542457-9cfa-ea27-d0d8-66e62bdbf3f7" + }, { + "reference": "urn:uuid:5cf21de5-b7f3-0090-6719-d1ec48728e95" + }, { + "reference": "urn:uuid:a06dffbd-e266-8a2c-428d-9b57ae44a5c8" + }, { + "reference": "urn:uuid:d1753e1b-62b8-c8c0-440c-0312d8fafa66" + }, { + "reference": "urn:uuid:34521130-ee86-e7e7-e655-47cc3ba74800" + }, { + "reference": "urn:uuid:43603b05-ba17-d526-8b5d-1379dbca2ca1" + }, { + "reference": "urn:uuid:7aa5e536-8c0a-9a98-8f6a-232c3e8025af" + }, { + "reference": "urn:uuid:266f1b6e-9b07-46b9-1f7a-3284e4e57fea" + }, { + "reference": "urn:uuid:ea3013cb-b562-cf62-7933-aed5ef46ea8f" + }, { + "reference": "urn:uuid:311cc844-3ee7-4e52-c320-d22456ac98d1" + }, { + "reference": "urn:uuid:5007a435-6fc0-5537-3936-abf6dc98d0e8" + }, { + "reference": "urn:uuid:b23753f8-96fc-56b7-c06f-ae57183b901e" + }, { + "reference": "urn:uuid:969cb98c-207f-273e-f9cb-11f2f4ab0440" + }, { + "reference": "urn:uuid:d4f063c5-9383-c224-833e-bb62fc11c1a0" + }, { + "reference": "urn:uuid:bdb986db-5056-8ac8-ea30-eb030669e1c8" + }, { + "reference": "urn:uuid:bf4c36d5-510e-4eae-3c40-f71e47fb9f7c" + }, { + "reference": "urn:uuid:3e59a91a-de23-1588-0d6a-6275a76acfd1" + }, { + "reference": "urn:uuid:986d30be-3799-e3ed-396d-8c258100ec0e" + }, { + "reference": "urn:uuid:cef2fe42-64f6-9a45-8871-6b56743585ee" + }, { + "reference": "urn:uuid:33725ecc-1c24-03b2-e41e-4f1080021626" + }, { + "reference": "urn:uuid:de4d9b18-48a6-2894-f71f-773833cc1cee" + }, { + "reference": "urn:uuid:085f9a4f-a6af-07d4-3802-6b163590072d" + }, { + "reference": "urn:uuid:39b6bb14-b071-5a9d-cdb6-f51ad739e37e" + }, { + "reference": "urn:uuid:af0e7f6f-d5a2-0580-d877-6d8072cfba48" + }, { + "reference": "urn:uuid:0b706601-c94d-8c28-6ca6-44a057d1eb16" + }, { + "reference": "urn:uuid:6603439d-4d98-fe3a-2277-27069cf74af9" + }, { + "reference": "urn:uuid:39af7b26-a1d9-8a35-ede1-1edee1afd61d" + }, { + "reference": "urn:uuid:89ffdfb4-268c-e2fb-3c5f-2555b3aaa4fa" + }, { + "reference": "urn:uuid:e0f5d2cb-1ad3-c194-0ca9-12765cbe711a" + }, { + "reference": "urn:uuid:c20950c3-001e-7bdf-4630-a00cf728b61b" + }, { + "reference": "urn:uuid:851fbf6a-2d4f-fbd0-1675-765ed47bf988" + }, { + "reference": "urn:uuid:4d860c87-1fc9-f9ae-74b7-7b350d36843c" + }, { + "reference": "urn:uuid:8f144fd2-d06d-cbfd-b84a-dfdcbcf5f62d" + }, { + "reference": "urn:uuid:0ba23c6e-fa3d-e17f-a098-9f7a4f487b58" + }, { + "reference": "urn:uuid:f97b081e-162f-69d0-89a7-c5fe98345539" + }, { + "reference": "urn:uuid:e85ab627-db67-8ced-93fd-4517ea8d5f40" + }, { + "reference": "urn:uuid:8be87485-fcea-9364-f186-fdd1f53d0440" + }, { + "reference": "urn:uuid:3492ac8b-519c-5b34-e251-9a2c0d41330b" + }, { + "reference": "urn:uuid:fd33ff3b-44cb-c8a5-3ec6-3728ff83b63c" + }, { + "reference": "urn:uuid:0316867e-fbe5-2656-aa0b-5ea906fe39f7" + }, { + "reference": "urn:uuid:a8132d41-8f12-2ae5-1c6c-68c732556ea3" + }, { + "reference": "urn:uuid:3fed1dfa-187b-a9b7-d93e-2b3e15758001" + }, { + "reference": "urn:uuid:5288618e-fb5c-4c5c-aac1-6018785a1c4c" + }, { + "reference": "urn:uuid:22d47c81-bc56-556b-24ab-609c4779d5f4" + }, { + "reference": "urn:uuid:0b9b4ac8-82b1-c77e-09d4-998f997f4828" + }, { + "reference": "urn:uuid:6a638cca-dd08-05ce-6ee2-0047660d8e1b" + }, { + "reference": "urn:uuid:f59bc869-e84e-1654-aa5d-01fedcbc7e15" + }, { + "reference": "urn:uuid:c0d38ac3-ba6e-9329-cc18-f45bec0f6875" + }, { + "reference": "urn:uuid:82a9b9ae-a1f0-fd40-2f11-ebd805f75b6f" + }, { + "reference": "urn:uuid:9063768e-ca8a-a9df-a59a-c391d82025dc" + }, { + "reference": "urn:uuid:88a37917-2353-1c3d-b077-4f85a7ea2f2e" + }, { + "reference": "urn:uuid:8cef5bb1-b1b7-d577-f4b1-e208cf008fa8" + }, { + "reference": "urn:uuid:eea729c9-eb28-5c11-5928-ea4cd27b862f" + }, { + "reference": "urn:uuid:2b833a90-7db9-06f4-0044-5f5ea094101c" + }, { + "reference": "urn:uuid:90390935-4a42-6935-3c63-93988adc609e" + }, { + "reference": "urn:uuid:5504b9cd-faf7-d455-6e03-5f0a1166cc98" + }, { + "reference": "urn:uuid:42f4fd25-424f-cc3e-4e89-fef6490d3de8" + }, { + "reference": "urn:uuid:1052fd28-2e5c-28b8-1aff-2467cb9d7f59" + }, { + "reference": "urn:uuid:fa6f82ac-e0ed-3288-4ced-b043a18deb41" + }, { + "reference": "urn:uuid:2d228426-264e-8d6c-9837-e28a83bece54" + }, { + "reference": "urn:uuid:b61b0b79-a692-79f0-3d37-69c9aeead0a1" + }, { + "reference": "urn:uuid:97c09fb6-a348-0137-ce7c-9fe1fb385dbd" + }, { + "reference": "urn:uuid:eb27435d-1db6-d004-a944-8fdc31c36428" + }, { + "reference": "urn:uuid:170648e1-4ca5-1aa6-25c2-458704db9e8e" + }, { + "reference": "urn:uuid:afc50dd6-81cf-c3c6-b9aa-45ada3de52a7" + }, { + "reference": "urn:uuid:ee38fae0-28a6-d0f1-27d7-be6fabf60911" + }, { + "reference": "urn:uuid:105cf80d-085c-8425-deeb-d90c618c26f5" + }, { + "reference": "urn:uuid:9cf8c364-b7fd-9139-1a0f-49992f058c03" + }, { + "reference": "urn:uuid:523a0884-452e-141b-17d4-79e892b95804" + }, { + "reference": "urn:uuid:4c25335f-2bef-6c67-8e9e-805c3c93101f" + }, { + "reference": "urn:uuid:cd33cf82-0c6b-df4a-4383-f683e5e2817a" + }, { + "reference": "urn:uuid:4487f6cb-dc89-9ac5-f4f4-88f50ed543eb" + }, { + "reference": "urn:uuid:d97ef5bf-7e94-5cc5-c2e9-230dae199eed" + }, { + "reference": "urn:uuid:d25f8fd0-d58f-acd0-2cd7-d3e5d6c1c79b" + }, { + "reference": "urn:uuid:4b0d7c13-a3b2-4fe8-3010-323f399cc5e1" + }, { + "reference": "urn:uuid:ec714d5e-0e42-5b8b-c144-4dccda462c7a" + }, { + "reference": "urn:uuid:4c46f45b-75ce-c956-6178-82d720577771" + }, { + "reference": "urn:uuid:679dddb0-bf21-e77c-193d-f6597c2c2c29" + }, { + "reference": "urn:uuid:ff1be34b-0db8-7bec-11e0-f1553ab1bc82" + }, { + "reference": "urn:uuid:4fdc5840-9e5a-97d4-c8f0-1ed97ce02cbb" + }, { + "reference": "urn:uuid:5a2ea033-9008-9b9d-0017-3b936d449271" + }, { + "reference": "urn:uuid:e3a54d65-f1b6-0821-0d5a-472c0900dd6e" + }, { + "reference": "urn:uuid:955c6548-5841-a9b6-cc15-6d0245c3a452" + }, { + "reference": "urn:uuid:07149a54-fd80-bdf5-c235-76845f4bf27c" + }, { + "reference": "urn:uuid:85daa5ab-6f52-488b-cc7c-7ff14046cacb" + }, { + "reference": "urn:uuid:98194fae-a73a-3780-d8f1-3b4921b54084" + }, { + "reference": "urn:uuid:4a0c9578-4ba9-4ef6-b532-e82ac22b64db" + }, { + "reference": "urn:uuid:a19f0b23-9b49-7d0f-f6d6-85638a80ff49" + }, { + "reference": "urn:uuid:48f085bb-d0e6-118e-0fa9-568cfcd0bc14" + }, { + "reference": "urn:uuid:f85164ff-c826-fb64-13e8-43d7039fe174" + }, { + "reference": "urn:uuid:b29605c2-16d8-c4e1-ee15-0a673e927eb7" + }, { + "reference": "urn:uuid:3c85608e-465e-0171-e78c-40d74bef2d29" + }, { + "reference": "urn:uuid:6d2b79da-a22c-083c-dc9a-d6b067257cb9" + }, { + "reference": "urn:uuid:eec2dff5-2bfa-bd00-d5f2-3f032bb4168b" + }, { + "reference": "urn:uuid:48c8b560-d190-0df3-d811-beb8ec9b1972" + }, { + "reference": "urn:uuid:70da53c7-205c-e452-91ed-7c7574edc3f7" + }, { + "reference": "urn:uuid:ae6a5577-d5ad-027f-752a-b6e50eee3e75" + }, { + "reference": "urn:uuid:16fb72cf-f392-a04d-d466-04add07529fe" + }, { + "reference": "urn:uuid:84569152-4783-57a2-adb1-51e5a869d491" + }, { + "reference": "urn:uuid:c5c7dc03-b2c8-6e63-c774-24a733d1fc4b" + }, { + "reference": "urn:uuid:700cc5a4-c22e-89b0-3f34-4201c9905a8a" + }, { + "reference": "urn:uuid:9acc4703-30ee-2016-0848-8f51545444d0" + }, { + "reference": "urn:uuid:ec46d574-b248-53f7-265a-d63d56092da7" + }, { + "reference": "urn:uuid:5266d71c-9baa-d76e-1069-88aede6fcf33" + }, { + "reference": "urn:uuid:78ffd255-4b7a-106f-f1e2-207e2612f00d" + }, { + "reference": "urn:uuid:a2c75668-b4ba-9158-f382-3836e4e54e6a" + }, { + "reference": "urn:uuid:2d2494f9-0620-f5e4-32bc-025a4d686669" + }, { + "reference": "urn:uuid:c11834df-ed71-2486-ecd2-b6f73248ff7e" + }, { + "reference": "urn:uuid:7eccd987-26ac-b372-114f-4ed60533f313" + }, { + "reference": "urn:uuid:c19c1200-6e3c-209b-653f-ca42f107d74c" + }, { + "reference": "urn:uuid:300e9311-6442-573f-764b-9f7d767a7a07" + }, { + "reference": "urn:uuid:a786da51-2c96-ef6b-4046-4419f45d9770" + }, { + "reference": "urn:uuid:dea5b59a-6c2f-1b43-0700-505acb3fdcf4" + }, { + "reference": "urn:uuid:026fba8b-ee95-f843-2089-11481a6667fb" + }, { + "reference": "urn:uuid:c6aa5133-e54a-fb02-3669-4b46462391b8" + }, { + "reference": "urn:uuid:452d53ae-0850-bacf-9e5c-f67ed6df9bce" + }, { + "reference": "urn:uuid:26085ea0-2375-0b24-9d10-5969a08b9158" + }, { + "reference": "urn:uuid:4098305a-1858-11f8-c94b-bcdc10593052" + }, { + "reference": "urn:uuid:8baf7c38-565c-e5bb-3c53-1ff098dfb172" + }, { + "reference": "urn:uuid:c70a1aca-c5b6-e20a-a072-dd4bf5983a39" + }, { + "reference": "urn:uuid:03cbe148-d96a-e73b-991f-25d03acf0873" + }, { + "reference": "urn:uuid:63400871-9da7-ac42-7b52-76a0405a2265" + }, { + "reference": "urn:uuid:3378397d-3667-cfc3-2230-fd4ab13a2839" + }, { + "reference": "urn:uuid:5374f914-2c0a-06fc-aeca-a2f6273cb3e6" + }, { + "reference": "urn:uuid:424db386-ada2-db7d-3de5-ab07b1cf3d64" + }, { + "reference": "urn:uuid:84877c3c-96de-bdec-1d28-78c148053cfe" + }, { + "reference": "urn:uuid:270f0e9b-b387-bff2-52c7-b5a944b0cb88" + }, { + "reference": "urn:uuid:361b431f-fb2d-db98-78e7-4792b8afa75f" + }, { + "reference": "urn:uuid:d47cbacd-4ae1-dc89-445b-9abaf4332e6f" + }, { + "reference": "urn:uuid:1945504c-59ce-7be7-9d42-b50ae5119622" + }, { + "reference": "urn:uuid:de4d853c-d65d-462c-f71f-615cc1833a86" + }, { + "reference": "urn:uuid:7a8d9d88-04b2-64f2-a4ef-356b59e9efc2" + }, { + "reference": "urn:uuid:2ae82313-524e-557a-666c-4b4910da5fb4" + }, { + "reference": "urn:uuid:4758fcac-84a9-de7e-a73b-0e68d13ea729" + }, { + "reference": "urn:uuid:611a460c-a446-ad0e-3282-a95414c659a6" + }, { + "reference": "urn:uuid:c6e3cf74-9f9a-e47a-c448-8dffe2b51ffe" + }, { + "reference": "urn:uuid:dc33d877-ccbf-9654-2a3d-937b4306b6cb" + }, { + "reference": "urn:uuid:2db5d594-6011-1b25-6ad2-f356745edf84" + }, { + "reference": "urn:uuid:72ebe461-b488-6aa0-ca78-4e4d9019fe5d" + }, { + "reference": "urn:uuid:034f41b6-777b-3a84-00b4-0041ba957608" + }, { + "reference": "urn:uuid:305a8773-54f1-1227-0236-a75e7ae56c40" + }, { + "reference": "urn:uuid:e8b15c2a-d1b6-fd45-5516-347c21eb3068" + }, { + "reference": "urn:uuid:5b053647-433b-f2fd-4542-536505507ab1" + }, { + "reference": "urn:uuid:86600c15-53b5-6445-4a56-833dce7ec62b" + }, { + "reference": "urn:uuid:5de2420d-bec4-626a-2f4a-a5552f440f02" + }, { + "reference": "urn:uuid:ddceaf5a-df7a-d61a-db33-6de62295119e" + }, { + "reference": "urn:uuid:87c643d9-7f76-aad6-51cf-e70020ebabbf" + }, { + "reference": "urn:uuid:374f1211-df29-e17e-ef91-a317cf858521" + }, { + "reference": "urn:uuid:0ffa33af-69f3-ddc9-12e4-599d515fe6cc" + }, { + "reference": "urn:uuid:9b56227c-7f69-6fd8-bc0c-db87a91a5b85" + }, { + "reference": "urn:uuid:f09092f2-0b0b-3ffc-9e53-98256035ed2e" + }, { + "reference": "urn:uuid:21b2512a-a9b8-e831-f7f2-a3d2bcd90c07" + }, { + "reference": "urn:uuid:9755901c-1752-314e-00e4-a8e33cd34461" + }, { + "reference": "urn:uuid:f4333f56-6d5b-7086-85f8-6c59b9106dd5" + }, { + "reference": "urn:uuid:1b6c052c-51f8-0ae9-4b1f-cd29ee80a179" + }, { + "reference": "urn:uuid:a6f98e00-1aa1-c10b-bb09-8cd54b2300a9" + }, { + "reference": "urn:uuid:e6f53589-e315-e5a6-f90f-cf69c4af726b" + }, { + "reference": "urn:uuid:0474fc56-8677-4fa1-2f94-e32f88698dac" + }, { + "reference": "urn:uuid:b85806f2-eed1-78e7-afd3-fd83d3f68c5f" + }, { + "reference": "urn:uuid:b88c5d40-5348-701b-a502-030f3a85c54d" + }, { + "reference": "urn:uuid:c72dd41b-2751-4699-2076-870405d92866" + }, { + "reference": "urn:uuid:f4559626-b9a9-71b6-b921-78f533062822" + }, { + "reference": "urn:uuid:0f5c8424-46a6-97d2-3463-85be1181976e" + }, { + "reference": "urn:uuid:13d5657c-ab0a-81e7-4cbe-e86e289663c6" + }, { + "reference": "urn:uuid:9efbb839-4ffb-06f2-0418-9c383fa02e79" + }, { + "reference": "urn:uuid:7db29bf8-c95d-6026-8f27-18bebf846255" + }, { + "reference": "urn:uuid:47472be1-4df0-48de-52a3-3acc3a53523b" + }, { + "reference": "urn:uuid:2f0dfe6a-9d63-652d-4811-3988c421e13a" + }, { + "reference": "urn:uuid:03332088-43cf-bb54-0d7a-041da65e4a35" + }, { + "reference": "urn:uuid:acb0bdd6-2cce-554e-88c6-c16f7317447c" + }, { + "reference": "urn:uuid:0256a7e2-aab6-6475-d2d7-3b381ec2d93d" + }, { + "reference": "urn:uuid:97671859-6938-eb58-abdb-8f61bb700803" + }, { + "reference": "urn:uuid:f469fdef-5386-02ed-5224-ae688b3a394c" + }, { + "reference": "urn:uuid:816773ac-f8c6-19d1-11f2-c96d0931339c" + }, { + "reference": "urn:uuid:c8ecde36-9db4-6997-7e8b-bb4e6237a8f5" + }, { + "reference": "urn:uuid:56526c47-8f7a-f1a9-53b7-2ad2d2952d2d" + }, { + "reference": "urn:uuid:2ed37c3e-6e45-9ae6-00af-9c299439f4ff" + }, { + "reference": "urn:uuid:30312e31-7211-6dda-eb95-086c076b70da" + }, { + "reference": "urn:uuid:bb729c7a-0673-677a-10fc-d6b58a9c8309" + }, { + "reference": "urn:uuid:3f4a08f5-6764-8944-c960-b65b4def1323" + }, { + "reference": "urn:uuid:b5b1a2d0-3683-4c46-203e-51553a4d4b4c" + }, { + "reference": "urn:uuid:7030faa8-1b89-b38e-20da-6578ca0b0f00" + }, { + "reference": "urn:uuid:949083fe-1915-c5a6-d7f4-8532c2657ede" + }, { + "reference": "urn:uuid:d38f3ec5-00c4-7cf6-7e87-45614709740b" + }, { + "reference": "urn:uuid:74c7a353-de01-4f89-2578-04b489af20c0" + }, { + "reference": "urn:uuid:2375721f-7d23-b9e0-5ae0-c10707894dc2" + }, { + "reference": "urn:uuid:a679555e-095b-0c9c-1355-12c24c4c51f0" + }, { + "reference": "urn:uuid:d9762962-7ed2-a160-1227-591a5d40cb46" + }, { + "reference": "urn:uuid:64d4ac33-3c0b-e627-e505-febf69b2caaf" + }, { + "reference": "urn:uuid:5b067713-153a-7115-bb41-99252a821cf3" + }, { + "reference": "urn:uuid:783ea612-2132-b17e-ab33-7b9a17acfd94" + }, { + "reference": "urn:uuid:e7d28c3d-637e-892c-a77b-b82c4ac34b4f" + }, { + "reference": "urn:uuid:71535973-8924-b97c-b03d-458812a6a9aa" + }, { + "reference": "urn:uuid:0974acc8-0aa8-2917-e0d3-070306e8c9bf" + }, { + "reference": "urn:uuid:58c3192a-a4e1-353a-63bf-f86ac86702d4" + }, { + "reference": "urn:uuid:cfe4901c-72be-79bf-1fe7-26ab53c8fc58" + }, { + "reference": "urn:uuid:f9d29ace-432e-381f-914d-94e4f24e2fb6" + }, { + "reference": "urn:uuid:14823687-f224-0d5d-e654-cc753b79a5a7" + }, { + "reference": "urn:uuid:c87ca188-79f4-39d4-dc7d-452c3236da7a" + }, { + "reference": "urn:uuid:9dcc68bc-283e-e159-66dd-258fa4bb02c8" + }, { + "reference": "urn:uuid:5e9385e5-478c-044b-d154-d3c683e4f7c1" + }, { + "reference": "urn:uuid:86359947-8d36-67a3-e97d-09c739ce390b" + }, { + "reference": "urn:uuid:0fa8e99a-952d-d0e5-ce34-2cb4d0b1ce49" + }, { + "reference": "urn:uuid:1f7d893e-c6c4-596e-ae8d-2305f4f837a7" + }, { + "reference": "urn:uuid:2fbb2c4a-863e-8f66-0197-4d9ad9488fb8" + }, { + "reference": "urn:uuid:06613751-4755-cb2a-9f34-21ca6b387894" + }, { + "reference": "urn:uuid:345d87a1-78fc-4fe1-6f3d-56dd1f539370" + }, { + "reference": "urn:uuid:d78955fb-cd7f-d17b-2f97-595ac8c30d33" + }, { + "reference": "urn:uuid:af46e0ef-f26d-2247-6e94-ee72144b9234" + }, { + "reference": "urn:uuid:c9ee53df-9c23-b554-9c48-f9fd625e531a" + }, { + "reference": "urn:uuid:e778b4f1-7a5d-234c-4771-5ec51f638792" + }, { + "reference": "urn:uuid:c30ba9bc-ca8e-6eb7-1148-c3ddf3544f20" + }, { + "reference": "urn:uuid:18b10999-4e4c-152e-1d74-3cd972007646" + }, { + "reference": "urn:uuid:42ba6694-d549-6aff-09ea-8f98b4e49116" + }, { + "reference": "urn:uuid:c0fbce38-6b16-e4eb-06a9-885b58a23f59" + }, { + "reference": "urn:uuid:30349553-3bcf-5955-2a08-e578019d47c7" + }, { + "reference": "urn:uuid:c3d76a0e-5a7d-ec80-0941-351db155bec9" + }, { + "reference": "urn:uuid:dca1f527-5066-a553-efad-96cc1432e49c" + }, { + "reference": "urn:uuid:6b8486f4-56cc-b005-2e13-d9f085ef8921" + }, { + "reference": "urn:uuid:5299edd3-ab61-ad7a-02be-f9b18a9967b4" + }, { + "reference": "urn:uuid:4d1d7469-0b2b-f4fe-83ba-9f7abb7b15c4" + }, { + "reference": "urn:uuid:8dc2089d-3117-6b00-a056-8cdbbaeebeb3" + }, { + "reference": "urn:uuid:25028563-eec5-285b-a0c5-951b9bfd2b82" + }, { + "reference": "urn:uuid:2c2cca8b-312a-01fc-8388-1e0169109915" + }, { + "reference": "urn:uuid:24bdc532-0150-4bc9-b7e7-8311faa04a98" + }, { + "reference": "urn:uuid:578d4230-c5e1-0923-3b0b-e82c76198bb3" + }, { + "reference": "urn:uuid:87b405ea-2be2-6cab-103c-9d834050e129" + }, { + "reference": "urn:uuid:86134b9e-5950-0942-1fb2-a62deb5561bc" + }, { + "reference": "urn:uuid:1516838a-9583-c2e8-a2f7-2011ee28fa4d" + }, { + "reference": "urn:uuid:97b3c02a-4740-35d9-f676-93c61b819603" + }, { + "reference": "urn:uuid:34d26b47-672d-0be3-4eb4-565eb5c35bf2" + }, { + "reference": "urn:uuid:fc2f8e05-b15d-e7d4-64f0-86bacd2ae887" + }, { + "reference": "urn:uuid:bde251c9-848f-baaa-e49b-5dc069a66686" + }, { + "reference": "urn:uuid:4d6d73f2-cf71-713d-124b-20bd93cbb55d" + }, { + "reference": "urn:uuid:71493639-ab0e-9051-868e-53576d240ceb" + }, { + "reference": "urn:uuid:7fc36101-da53-87c6-9e0e-316213772c1a" + }, { + "reference": "urn:uuid:b6277851-2948-ed94-6db9-ad24a1819745" + }, { + "reference": "urn:uuid:b67b969e-018d-73bb-660e-d946a5312bfe" + }, { + "reference": "urn:uuid:70c923ab-167f-d37a-1f27-92ea0b5db84b" + }, { + "reference": "urn:uuid:14e910a7-e2cd-9814-a1fd-62d34a4858f1" + }, { + "reference": "urn:uuid:e92e9f99-1fee-7d33-9054-a33a9dace1d2" + }, { + "reference": "urn:uuid:db745486-d1e0-48b1-d14b-ec706e4db0f1" + }, { + "reference": "urn:uuid:2bd4b9f2-9b27-ab41-37d8-44ca40ce6f85" + }, { + "reference": "urn:uuid:b24760b5-22ef-89f2-118d-024240b188a5" + }, { + "reference": "urn:uuid:0ff48303-ea3b-0fcc-1fea-15fe1747f8ba" + }, { + "reference": "urn:uuid:35c68e5b-f136-05b3-1c0e-1947a9792710" + }, { + "reference": "urn:uuid:9c47a97a-a1a9-6e16-d072-33b4dd2d990f" + }, { + "reference": "urn:uuid:de7b173c-6207-27c6-6f76-7ef1fe68ed2d" + }, { + "reference": "urn:uuid:34dbcc15-8cb5-1085-1750-24de19b46b1d" + }, { + "reference": "urn:uuid:cf127688-5fcd-80bf-fd4f-a86ca5b62800" + }, { + "reference": "urn:uuid:36e3a5f8-f487-175f-ccd1-df64be457b19" + }, { + "reference": "urn:uuid:9ed0e812-0ac6-824f-a99b-239ff9d77b8f" + }, { + "reference": "urn:uuid:c6c1515d-e9fe-e3bf-1062-495652b59b90" + }, { + "reference": "urn:uuid:dd0ec517-0eb1-3b4a-9fdc-28c7799b4873" + }, { + "reference": "urn:uuid:e84b8c4e-8f59-876c-7519-afcf723b07d4" + }, { + "reference": "urn:uuid:122c5ebd-6fcc-912b-c0a7-718e94792eb7" + }, { + "reference": "urn:uuid:9edf3992-fed3-0745-f9a9-b26d148f9782" + }, { + "reference": "urn:uuid:c9ccf4d1-3253-0d57-104c-44df18941c3a" + }, { + "reference": "urn:uuid:ea9b7994-b22e-c141-e4a9-8e1959316ea4" + }, { + "reference": "urn:uuid:6731a298-d504-b917-3e54-1d83c16b6052" + }, { + "reference": "urn:uuid:ae861a19-05d0-3c22-39e5-ab33c9899810" + }, { + "reference": "urn:uuid:7282d936-356a-d7ae-351f-b31b61f21ac7" + }, { + "reference": "urn:uuid:07e8e1eb-b585-3bd5-9a75-f389a9fcfedc" + }, { + "reference": "urn:uuid:ba36ab8a-4526-e098-1938-61870688b61b" + }, { + "reference": "urn:uuid:f2f4cda6-a1c8-9396-d766-15db68af271e" + }, { + "reference": "urn:uuid:5f3ddcf5-4d4f-fa29-8a95-c52923bc235f" + }, { + "reference": "urn:uuid:288a917c-8995-416c-5597-7a6a998ad466" + }, { + "reference": "urn:uuid:5976eebe-021e-cfb7-060e-c02665664037" + }, { + "reference": "urn:uuid:246be321-9339-5ce9-7c78-576444aa48f9" + }, { + "reference": "urn:uuid:796617ef-c3cf-bb71-8426-a5c2a65e4a52" + }, { + "reference": "urn:uuid:e0032b03-1c7a-e822-0744-1c071e698e10" + }, { + "reference": "urn:uuid:639649eb-3121-ddee-9e14-796fded96ae0" + }, { + "reference": "urn:uuid:6ce88523-0479-4114-94db-bae334419f23" + }, { + "reference": "urn:uuid:3ae59a87-91cf-2148-a2ad-599dd6d850ee" + }, { + "reference": "urn:uuid:895d2cdc-bd99-0209-edd8-fff1274a91c2" + }, { + "reference": "urn:uuid:0f8b0d61-35f8-d71c-dd39-674e7b5b80c7" + }, { + "reference": "urn:uuid:ee679726-e65b-fffc-9dfa-bf9992096bb9" + }, { + "reference": "urn:uuid:34d2ae48-e63a-185d-431c-2642b63bb9cc" + }, { + "reference": "urn:uuid:c7f443cd-874a-f245-60a4-4370b7c13b7c" + }, { + "reference": "urn:uuid:79374e32-7456-4d67-27d0-5aa2bfd94826" + }, { + "reference": "urn:uuid:509d39f1-1e9b-96f9-eebd-64e7c8b8bb97" + }, { + "reference": "urn:uuid:3f381250-5c63-0604-9124-be1ee4b7e0cf" + }, { + "reference": "urn:uuid:facdd3ed-5de2-97e0-4f8b-89f55c5a8275" + }, { + "reference": "urn:uuid:888ab828-bc48-50b3-b2a4-40dee36e26da" + }, { + "reference": "urn:uuid:8f6c83f9-e0ff-734f-36b0-eff3796a268d" + }, { + "reference": "urn:uuid:c41e7d71-dd69-7e96-2045-54a20f1a4881" + }, { + "reference": "urn:uuid:6c5c4ead-2dbe-af34-7fee-ea5166218744" + }, { + "reference": "urn:uuid:23f98d60-2636-0a34-f246-4758d6bc5769" + }, { + "reference": "urn:uuid:b195bb97-cdf9-4d09-a0f1-0a56d028f6af" + }, { + "reference": "urn:uuid:1d44cbbe-9a1e-c75b-ff0d-42476f98bc13" + }, { + "reference": "urn:uuid:8c9df7f3-0c2a-1f29-9ff5-dd7792a2fee8" + }, { + "reference": "urn:uuid:823428be-69ef-f835-c97b-9943e6f0dad6" + }, { + "reference": "urn:uuid:e55ae35f-d452-875f-83d3-dbef2772584a" + }, { + "reference": "urn:uuid:2764c20b-e983-c2ea-67d9-47d7695493b6" + }, { + "reference": "urn:uuid:35071234-368e-2868-290a-9cb953abea7e" + }, { + "reference": "urn:uuid:8cda3b56-0b02-fb62-66ea-64e7d461f27c" + }, { + "reference": "urn:uuid:65d71f2d-5fe4-e2b9-8661-ea0917fc3f72" + }, { + "reference": "urn:uuid:833869ef-a571-5471-8603-b787b72e6f0d" + }, { + "reference": "urn:uuid:bf8f070e-6686-4d6b-db00-665dac9ffbcf" + }, { + "reference": "urn:uuid:57879f8b-b7cb-914f-403b-d12f700b679b" + }, { + "reference": "urn:uuid:12a828f2-23a5-862a-115a-8837c532a3ec" + }, { + "reference": "urn:uuid:b23f4642-2b7d-c23f-d8e7-3d525185e0d3" + }, { + "reference": "urn:uuid:d74b1199-fd9d-9f71-2b74-7a880e4d3f8e" + }, { + "reference": "urn:uuid:c10aa468-a113-3b89-7b04-5ce3eae8ff85" + }, { + "reference": "urn:uuid:342229ab-18e4-1708-2232-1f3e131123f1" + }, { + "reference": "urn:uuid:9a65ec95-c3fc-c454-02c9-340643a95c26" + }, { + "reference": "urn:uuid:404160ca-9087-59fc-3fe4-e0ef8a53772f" + }, { + "reference": "urn:uuid:a50a9c8c-ac92-2305-44c4-d6c830be5e7e" + }, { + "reference": "urn:uuid:07531b39-aefd-127b-1544-7fac8bf03504" + }, { + "reference": "urn:uuid:09b2c873-1960-8651-58c4-d3878f6a87fd" + }, { + "reference": "urn:uuid:21c68e1d-fceb-dc07-8c87-8807f2e5e4e2" + }, { + "reference": "urn:uuid:2e37b68b-011a-6346-6f50-725d2a5380f4" + }, { + "reference": "urn:uuid:33bde865-08c4-c7e1-e9dc-02fdc3a52e96" + }, { + "reference": "urn:uuid:bbcef629-fb49-2506-fb9d-fdac53cf04d4" + }, { + "reference": "urn:uuid:97dd5a92-0d99-630d-83f9-066bb2fecbaa" + }, { + "reference": "urn:uuid:95934d59-422b-db0d-94cd-2eac98f24089" + }, { + "reference": "urn:uuid:222b0963-8dc6-498f-efc4-d80689c26bbe" + }, { + "reference": "urn:uuid:556b95e9-3e72-a7c6-df33-4564eb91fd3d" + }, { + "reference": "urn:uuid:def9fcd8-7041-50a0-ff7d-529f1a3d0a2f" + }, { + "reference": "urn:uuid:6c80a9c0-284f-d35c-bf8d-d2b7c333382d" + }, { + "reference": "urn:uuid:7df80ed6-34b1-9abd-6641-52abb1474586" + }, { + "reference": "urn:uuid:236790d7-419e-f0f6-0092-8c24ac236c84" + }, { + "reference": "urn:uuid:bdbd30fb-ee5c-37cf-de96-bb437764f024" + }, { + "reference": "urn:uuid:4652f639-74f6-c297-f816-6cff6308de32" + }, { + "reference": "urn:uuid:0533a36d-d1a7-2b94-107d-c97eb1eb835c" + }, { + "reference": "urn:uuid:eae79b43-f482-f0eb-4a51-02e334f6e9d7" + }, { + "reference": "urn:uuid:75718bef-126b-853f-62e8-0c7bf36ab5ad" + }, { + "reference": "urn:uuid:e0dd6c0c-73b4-5e70-b939-5f70ac7fd9cf" + }, { + "reference": "urn:uuid:1ce9c759-3243-f943-a16d-2931686b8774" + }, { + "reference": "urn:uuid:5ad91d4d-69d8-6d7e-1207-d93eb549de93" + }, { + "reference": "urn:uuid:77d17e37-1d98-7c7a-0ff4-e416c0daf56e" + }, { + "reference": "urn:uuid:45ba5a8b-1498-0a29-c60b-ed0e6182bba7" + }, { + "reference": "urn:uuid:4d15a32f-0316-7b88-ffcd-6e69ea7a7df6" + }, { + "reference": "urn:uuid:d3b17ae6-d64f-639d-edd8-3669518708c8" + }, { + "reference": "urn:uuid:6118c25d-1f2e-115f-8b27-178c27ed6fd1" + }, { + "reference": "urn:uuid:8e65ccfa-5558-a1bf-9a90-d48ff862d62b" + }, { + "reference": "urn:uuid:542ee982-6708-4c5f-97a4-6f1a2e699796" + }, { + "reference": "urn:uuid:390c2c7e-f0d1-ac3a-08a9-eaef6e48f795" + }, { + "reference": "urn:uuid:7dacd15f-ce76-5823-ad85-2a9f192acc99" + }, { + "reference": "urn:uuid:ce40185d-82e2-2fca-3e08-3f21ba842980" + }, { + "reference": "urn:uuid:b497b936-65dd-a9b5-bb62-15989d28c167" + }, { + "reference": "urn:uuid:318981f8-b539-f318-29ae-7ccdb658a661" + }, { + "reference": "urn:uuid:5cf9df02-55fc-9649-1701-081426dfb3f2" + }, { + "reference": "urn:uuid:7da951ef-ce20-215c-b7e4-d61ca4fa20e6" + }, { + "reference": "urn:uuid:78bdcaea-018e-1f58-5696-d67902bf43a8" + }, { + "reference": "urn:uuid:137533fc-2d99-cea0-01ef-1df9ed39d89c" + }, { + "reference": "urn:uuid:d86a92ba-0db4-5273-d693-fba81e67addb" + }, { + "reference": "urn:uuid:e9549d06-1caf-9275-8158-5ca7f6a1e552" + }, { + "reference": "urn:uuid:a6ea53b6-42f1-ea19-1321-79aca99f6643" + }, { + "reference": "urn:uuid:0c0965c4-d2ce-95e7-b5bb-fb371ecfecc0" + }, { + "reference": "urn:uuid:7d2d4382-62f1-ca85-b57f-24f34734d2e0" + }, { + "reference": "urn:uuid:d124c492-653a-8b46-ca2e-e70da1a82c7f" + }, { + "reference": "urn:uuid:85a9c190-5d04-8bbf-03a8-56b7425b07ea" + }, { + "reference": "urn:uuid:8b63b92b-c27b-7e04-3efa-f01c28edc1d3" + }, { + "reference": "urn:uuid:0dd89f89-0d7e-797e-f68c-d12cc5be4fc9" + }, { + "reference": "urn:uuid:c1299ea4-aba5-9495-bfdb-fdea4d32b257" + }, { + "reference": "urn:uuid:587da5a6-62e7-a10c-ba64-18a51ed4ad22" + }, { + "reference": "urn:uuid:9643c55f-37b0-b632-ff31-d6129318b45b" + }, { + "reference": "urn:uuid:fcf9634e-70d2-ccc9-f50a-4f78443a54b1" + }, { + "reference": "urn:uuid:c7f52b84-0950-6580-257e-633d625d1d51" + }, { + "reference": "urn:uuid:5e081646-b540-7946-eea6-19e5b8188737" + }, { + "reference": "urn:uuid:27f43a81-9e80-623b-991d-d3fa61dcb961" + }, { + "reference": "urn:uuid:121d5201-09c5-46bc-6908-03424156b865" + }, { + "reference": "urn:uuid:afa8c5b1-ad22-81ac-f1e5-721eb1360221" + }, { + "reference": "urn:uuid:54e17884-7ef5-174a-7d49-c5f3463a6480" + }, { + "reference": "urn:uuid:abe9a9be-a2c2-8d6b-7cfb-8c073f8d67e2" + }, { + "reference": "urn:uuid:9dd239de-9c4b-3f10-4e1c-b411ef401536" + }, { + "reference": "urn:uuid:4da92f7a-97e6-f046-dbd6-44ced35117af" + }, { + "reference": "urn:uuid:15e24a56-f16b-04e4-24c5-243c849ea518" + }, { + "reference": "urn:uuid:563ba90c-dc50-16e8-c7c3-184a15016212" + }, { + "reference": "urn:uuid:5152a9a0-e36e-8c35-8e75-1ff74400d1e5" + }, { + "reference": "urn:uuid:d3e2d793-f2ec-8799-fc7b-592e0aa9277f" + }, { + "reference": "urn:uuid:28b021b5-115c-19df-be5d-5b5c062041c5" + }, { + "reference": "urn:uuid:de4d58c4-fa81-32d2-f71f-34e4e5a7272c" + }, { + "reference": "urn:uuid:e0b18a4f-a7a9-82b2-1054-5b16368a820c" + }, { + "reference": "urn:uuid:4bc41cfa-be2b-764e-99b1-a85c396d3ac0" + }, { + "reference": "urn:uuid:c2d59c9d-0222-96eb-5ed1-40ae496a0771" + }, { + "reference": "urn:uuid:a71a136b-1c13-32bf-93e3-1c6751c8c730" + }, { + "reference": "urn:uuid:ad4ea853-b11b-261f-6f4d-5ab2f6bcb33d" + }, { + "reference": "urn:uuid:0e8d3b94-3b30-0f38-1b76-29a430c30965" + }, { + "reference": "urn:uuid:0bc34be5-40e3-b565-2f86-a35034bae75e" + }, { + "reference": "urn:uuid:fd39d709-cff1-6ccc-400c-0a768b951085" + }, { + "reference": "urn:uuid:1d796608-df67-0943-f000-76cb473a7299" + }, { + "reference": "urn:uuid:9d2ece86-2a18-8cce-ea6a-bcc917e96242" + }, { + "reference": "urn:uuid:9f207caa-f3d2-e264-ce73-56be905875c0" + }, { + "reference": "urn:uuid:48078e6c-4269-645b-b46f-8f133d711c2d" + }, { + "reference": "urn:uuid:48300ec1-d392-4e73-5db1-083f0147ce24" + }, { + "reference": "urn:uuid:e2f79fab-b2a8-fe27-1cce-69fa1023a5c4" + }, { + "reference": "urn:uuid:a2b54b0d-5ab8-97a8-0677-f7d6043b151b" + }, { + "reference": "urn:uuid:33f18940-8539-6a0a-2622-5a0661831b70" + }, { + "reference": "urn:uuid:c7d20230-2431-2c47-15de-de84ae65b02f" + }, { + "reference": "urn:uuid:be86d6ff-dcf9-ea5c-3741-759f1eab4176" + }, { + "reference": "urn:uuid:9a96a4fe-03fa-bfab-5986-53bc5d53c5e2" + }, { + "reference": "urn:uuid:dce82c7a-8de6-e94d-57fb-050f95f16452" + }, { + "reference": "urn:uuid:f51368ee-c2cb-c9f3-1932-f4c9135ba5cb" + }, { + "reference": "urn:uuid:bc2d467f-88ba-088d-4909-ec55fcabf5c2" + }, { + "reference": "urn:uuid:8ac33c78-0bdc-e8d6-a494-4656907deabb" + }, { + "reference": "urn:uuid:5fb4fda1-503b-728b-33fb-aafbc12d08f3" + }, { + "reference": "urn:uuid:a2fb469c-6787-83be-71cf-3784bc45b6f5" + }, { + "reference": "urn:uuid:6c682b3b-3b1b-9189-9ed5-a07fc6d56161" + }, { + "reference": "urn:uuid:95404801-7a4c-775e-3c9a-f1092df67743" + }, { + "reference": "urn:uuid:dd162faa-c62e-438e-9a17-5ef2a6fc63c3" + }, { + "reference": "urn:uuid:0b637cb0-0eb6-9dc1-b9e2-98a96883045d" + }, { + "reference": "urn:uuid:6dead661-ac0d-246a-1e51-a8647c20a7a5" + }, { + "reference": "urn:uuid:4ab6a005-d1b5-f3cf-7b5f-8f9899549b5e" + }, { + "reference": "urn:uuid:20a8aed3-68f7-eff9-45f9-cdfa77d8f4e4" + }, { + "reference": "urn:uuid:fb18257a-da00-d8bb-339c-c6ba74f82d70" + }, { + "reference": "urn:uuid:effca375-b825-522b-4e6f-0fa5b7f4558d" + }, { + "reference": "urn:uuid:22613f52-af93-8e7e-7317-b0dccc16807a" + }, { + "reference": "urn:uuid:0b43fa23-0102-459a-46c8-27e8adec4fd4" + }, { + "reference": "urn:uuid:01b5594f-e4ef-a1df-c1c4-25f1f2d75c8e" + }, { + "reference": "urn:uuid:137d9d32-ad1d-90d5-ef7a-286112a18bf6" + }, { + "reference": "urn:uuid:5e4cbea8-6664-1eff-b01e-9ac9d491864f" + }, { + "reference": "urn:uuid:c2e78f5e-6a3c-3885-0652-bcd8e6baf811" + }, { + "reference": "urn:uuid:5e5a316d-3fa9-c6a8-2d93-e9604bba23ba" + }, { + "reference": "urn:uuid:586bbab9-9944-c985-4693-4c024a88754a" + }, { + "reference": "urn:uuid:91fa83b3-2aec-f240-e8c5-28f9bde4cd0a" + }, { + "reference": "urn:uuid:2b41c046-9ea4-1b59-5fb8-c841682131df" + }, { + "reference": "urn:uuid:e797a18b-8fed-e6aa-d04b-d32f482dbcf6" + }, { + "reference": "urn:uuid:4c3824de-b09e-5c3d-e78d-c02251998ce5" + }, { + "reference": "urn:uuid:60e568f7-e372-d1f0-34f9-dd6eebce5d4a" + }, { + "reference": "urn:uuid:32f9d6fe-8ec9-cc77-53b3-289e3f96ee98" + }, { + "reference": "urn:uuid:50595b33-a59c-2396-2b3e-95ac383899d8" + }, { + "reference": "urn:uuid:2e9ad335-d555-2f28-2c4f-fb2ab5140b93" + }, { + "reference": "urn:uuid:baa3791d-8352-31fa-26ca-375e5dee2664" + }, { + "reference": "urn:uuid:fd7dc63f-672b-f5e8-fd6e-83e0425ac191" + }, { + "reference": "urn:uuid:1abd91b2-29f9-32e0-1852-1efc2fbcfab9" + }, { + "reference": "urn:uuid:3ef41f81-adbc-06dc-7737-70fa4859d111" + }, { + "reference": "urn:uuid:e89d8512-3a6d-39f4-ddbe-fe7466ac8995" + }, { + "reference": "urn:uuid:2a2553f3-43a6-93e7-282d-debe65f23cc4" + }, { + "reference": "urn:uuid:02370f86-bd94-8f4e-85e6-fee49f562845" + }, { + "reference": "urn:uuid:9a7cda6d-3748-3a8b-366e-d22ecf546504" + }, { + "reference": "urn:uuid:a8d7d8a5-521a-72f5-96a6-67865d8e235b" + }, { + "reference": "urn:uuid:e1b1a7b6-88f0-d32f-bb3e-0a267d12634c" + }, { + "reference": "urn:uuid:beb7b3af-0f46-e854-105b-ef1309ac12e7" + }, { + "reference": "urn:uuid:bbcd9f8a-4c57-f143-d549-132e049ace2f" + }, { + "reference": "urn:uuid:cabfff68-407e-3d99-0644-2d370215f4d4" + }, { + "reference": "urn:uuid:0f4b3cb1-754d-6846-1746-062e8bd39cbd" + }, { + "reference": "urn:uuid:3f97ab33-c99b-5267-713b-63739fe73b1b" + }, { + "reference": "urn:uuid:afda0cd0-9487-c059-58e6-603e1746f10f" + }, { + "reference": "urn:uuid:2ca9f17a-772f-6115-dcb4-fbb4b2b38ee3" + }, { + "reference": "urn:uuid:4997925e-b079-9673-2ab8-eb964dff90dc" + }, { + "reference": "urn:uuid:afd4a19c-1200-bd88-2ac7-bb89cde26db7" + }, { + "reference": "urn:uuid:5c5c8993-db72-0bd2-2d0d-6604ce2e32aa" + }, { + "reference": "urn:uuid:595ca76c-8708-be0d-14d5-ca19b68e82e2" + }, { + "reference": "urn:uuid:be472105-dbed-135f-25a6-756769244416" + }, { + "reference": "urn:uuid:d4b0822c-f69c-e658-d018-2f67c50a9e51" + }, { + "reference": "urn:uuid:e8c81860-586c-58d3-4f62-9c685fb1f5a8" + }, { + "reference": "urn:uuid:40c002f8-d2a3-5791-d8af-bf7a858ab3b7" + }, { + "reference": "urn:uuid:473c5aed-e76a-ac3d-344a-c993145fef5d" + }, { + "reference": "urn:uuid:2ba887bc-9117-6238-0183-8182127f7e78" + }, { + "reference": "urn:uuid:9bf77185-3b80-1f51-b0df-327accddaecf" + }, { + "reference": "urn:uuid:d0c861ff-d2b8-6aab-1221-3e4055f277d4" + }, { + "reference": "urn:uuid:e1a28779-4469-0f2e-f7a4-a646b9327fec" + }, { + "reference": "urn:uuid:340c796d-c40c-974a-d402-37b40f9fc1fb" + }, { + "reference": "urn:uuid:b5f18a8f-e6da-d75a-d72b-a02e43a7dd37" + }, { + "reference": "urn:uuid:d2ccdd7b-7cbd-943c-3495-60266676be55" + }, { + "reference": "urn:uuid:efe20f6e-c035-7bac-122f-21126357dee0" + }, { + "reference": "urn:uuid:66538902-415f-e682-a636-a6cdfddc351e" + }, { + "reference": "urn:uuid:8fe1357d-eb14-3cde-6375-f4778dbf6ff8" + }, { + "reference": "urn:uuid:9c527f8a-f00b-5073-5eca-2a30ca8e31f5" + }, { + "reference": "urn:uuid:532b1050-2a92-bcfb-eb72-01c2f564a4af" + }, { + "reference": "urn:uuid:9d41ee31-082e-1baf-d3af-e56e59a91177" + }, { + "reference": "urn:uuid:2bb3f511-7bb5-9b28-430e-34fbc0d2b8ea" + }, { + "reference": "urn:uuid:033e1495-1d83-60cd-4fe2-01f5e1e69e60" + }, { + "reference": "urn:uuid:54664a8e-470a-5830-b5c4-2dff7855f473" + }, { + "reference": "urn:uuid:c9a8ad09-7465-c5ff-3a2e-83996ef70d47" + }, { + "reference": "urn:uuid:4def79e2-0e65-7241-9b75-218971e4606a" + }, { + "reference": "urn:uuid:da652474-4849-e19d-237c-e8b8b2427a8a" + }, { + "reference": "urn:uuid:bab3b5a8-80d9-8dd4-c865-d234655ffe93" + }, { + "reference": "urn:uuid:5d5b8ffb-b2ff-35e7-1f5a-425af8a0c305" + }, { + "reference": "urn:uuid:2f0e1d94-8a6d-4f47-3bf7-0ba480004974" + }, { + "reference": "urn:uuid:4c199769-8fd2-ad4d-0c3c-f5cb631e1fcc" + }, { + "reference": "urn:uuid:8c3d4ddd-2ccb-3618-4e54-a81d17105336" + }, { + "reference": "urn:uuid:d836e047-d035-76b5-c4bd-8439a6f1d90f" + }, { + "reference": "urn:uuid:e8d113cd-1e04-28a6-9b87-1336442be47d" + }, { + "reference": "urn:uuid:c63e550e-b53a-c477-c246-90cdbf29a7b6" + }, { + "reference": "urn:uuid:6c07196f-3a73-5a3b-ce2b-a22a205dd3a1" + }, { + "reference": "urn:uuid:df2aa5bf-7cc7-88ed-4293-5db7b7238320" + }, { + "reference": "urn:uuid:0529c8b2-3e54-fb66-cbe1-02fc12a45d9f" + }, { + "reference": "urn:uuid:5e4661b8-e4f8-e74e-4e83-096cf1ecd121" + }, { + "reference": "urn:uuid:07cdb795-42f4-e724-b415-f077e51f8499" + }, { + "reference": "urn:uuid:eec23d0b-6b98-7426-7041-d20f32a89899" + }, { + "reference": "urn:uuid:f1ffef4a-25d8-7bc3-2677-c0e8c64dba11" + }, { + "reference": "urn:uuid:98862ad7-c773-7e62-89c5-7ec8237cee54" + }, { + "reference": "urn:uuid:e48a907d-1f9d-a7e8-98ac-4cecd1cb7ebf" + }, { + "reference": "urn:uuid:6632411e-cacf-8273-c2ad-aca48daf7bdf" + }, { + "reference": "urn:uuid:9513843b-3010-3312-fe01-94f6265827db" + }, { + "reference": "urn:uuid:89fed791-d6f0-b340-45fc-bd8c31313dc2" + }, { + "reference": "urn:uuid:26f1ee35-33f8-485c-4665-3786afafade9" + }, { + "reference": "urn:uuid:95f7650b-2d31-7cd2-fee5-75c62379719b" + }, { + "reference": "urn:uuid:fb66a78b-45f1-6dc6-3e52-80ab1915117f" + }, { + "reference": "urn:uuid:f40464ba-1092-836e-627e-39d34cd95b52" + }, { + "reference": "urn:uuid:3a058082-937f-6fd7-ccff-ad8f7c6d7fcc" + }, { + "reference": "urn:uuid:049d0d3b-b97d-c5ff-751c-b9d38ae62946" + }, { + "reference": "urn:uuid:8efab614-b8dc-e732-cf0a-effa67b58b14" + }, { + "reference": "urn:uuid:ffb8a004-53f6-3698-212e-8c1c00480875" + }, { + "reference": "urn:uuid:f0860fe5-1c93-2649-80b3-82287496584e" + }, { + "reference": "urn:uuid:95495e5f-0855-af73-d37a-565e04bd89cf" + }, { + "reference": "urn:uuid:9bc5c01c-18be-78e2-08e8-501dc6be99ce" + }, { + "reference": "urn:uuid:bf294b88-cbd0-1485-9558-3197a14a0b59" + }, { + "reference": "urn:uuid:740ac138-db90-ca85-2ee4-c0b3c78bc658" + }, { + "reference": "urn:uuid:801fcf1a-6d1d-6b57-0f00-daf518502de6" + }, { + "reference": "urn:uuid:1d8a57cd-eb37-257a-590e-873898022fb4" + }, { + "reference": "urn:uuid:7710f78c-be1e-364b-b615-c4048cd38c2c" + }, { + "reference": "urn:uuid:5b448a63-7323-2605-1d43-3cc2b8c4b323" + }, { + "reference": "urn:uuid:4e8dbda8-7d40-8d48-5b76-abb872d38775" + }, { + "reference": "urn:uuid:109b6cd4-cab9-1d60-7e85-cb74d0fdae3e" + }, { + "reference": "urn:uuid:a29280c9-0221-5425-8fe8-1a2a4968c4ab" + }, { + "reference": "urn:uuid:2493ba39-c798-7f09-5295-bb3da1e2b29b" + }, { + "reference": "urn:uuid:54f91b59-1aa4-3d4f-371b-d389e900aa02" + }, { + "reference": "urn:uuid:02746a0d-75a1-1c89-67d0-aa31de43a0ee" + }, { + "reference": "urn:uuid:18bec7f0-88ff-c3c5-65c5-b1120fbdfcd1" + }, { + "reference": "urn:uuid:eff82f55-0075-2183-5f5c-884d328803a5" + }, { + "reference": "urn:uuid:cfebdfd7-99cc-ca40-d55d-1e677c0f7147" + }, { + "reference": "urn:uuid:c14d40e2-95f2-9b03-391f-35eb45c092a5" + }, { + "reference": "urn:uuid:076c2f6b-4a21-5c65-af81-d599652575f6" + }, { + "reference": "urn:uuid:2fd3aeb0-b852-fa3d-2404-8438ec593f3f" + }, { + "reference": "urn:uuid:c4e2e189-98ad-4bc9-d69d-1bf7a9691347" + }, { + "reference": "urn:uuid:8d57de31-426e-32b2-34b7-4e361a00890a" + }, { + "reference": "urn:uuid:d7279d30-a504-3092-fc6d-22b72be8a77b" + }, { + "reference": "urn:uuid:25ff72eb-3d57-450a-6c6a-af25491f6e8d" + }, { + "reference": "urn:uuid:82717ee8-1e79-d257-bb31-0ce4fc35a9b3" + }, { + "reference": "urn:uuid:c4706ef8-6aa7-decc-16e5-43b36b7d1bd5" + }, { + "reference": "urn:uuid:ef3701e5-ce0b-d802-9374-bbd7f979ffcb" + }, { + "reference": "urn:uuid:330ebf10-d52e-8e9a-a920-bd7301f945d7" + }, { + "reference": "urn:uuid:27ac56ee-6623-6914-930e-3468f9cbd4e2" + }, { + "reference": "urn:uuid:1961cc95-2c63-26f3-2aec-a8045e58158b" + }, { + "reference": "urn:uuid:269ad745-21ba-1a38-9abe-94c4ba80b2d2" + }, { + "reference": "urn:uuid:bf9b2139-a16e-91b9-633e-d97c9ba3bdaa" + }, { + "reference": "urn:uuid:49420666-077a-3605-f22a-f49579678218" + }, { + "reference": "urn:uuid:ce23cf3c-b256-c728-359c-1ab8e7d27fc2" + }, { + "reference": "urn:uuid:bfa77c57-9db3-be88-9457-3ee62c94ca71" + }, { + "reference": "urn:uuid:fb95cc7a-af90-8eb6-d9bb-0611030d7033" + }, { + "reference": "urn:uuid:26e8727a-d997-d56f-afac-d30ea34e03af" + }, { + "reference": "urn:uuid:7cb28e81-8b0d-bede-7c2c-59f873e7b5c9" + }, { + "reference": "urn:uuid:c8563c68-9fe4-ce08-226f-0e44bfcff3fd" + }, { + "reference": "urn:uuid:45476136-0849-273c-9e77-0406d6d8083b" + }, { + "reference": "urn:uuid:31b38482-5e7d-8535-1995-debf8c353ce0" + }, { + "reference": "urn:uuid:26d2c28d-cbd1-db6e-43f0-84a59d7b3af3" + }, { + "reference": "urn:uuid:9cfb1ad6-78e5-15a3-de1a-448eea6eb8c4" + }, { + "reference": "urn:uuid:ae8e5465-bb30-7163-bb77-4275b0c36b90" + }, { + "reference": "urn:uuid:ef189725-d888-f66c-86e9-ff891ff97619" + }, { + "reference": "urn:uuid:15518f55-3a8a-e156-1d13-119e7d7c650e" + }, { + "reference": "urn:uuid:5d117b93-93b5-8ed9-74fe-b43b70d2ac9b" + }, { + "reference": "urn:uuid:1013438a-1648-794d-58a9-a6adb261e9c5" + }, { + "reference": "urn:uuid:0ab4a7c8-2678-f5ca-bd13-ed69b396b7c8" + }, { + "reference": "urn:uuid:68122543-16ed-7687-5622-1ad6111a8370" + }, { + "reference": "urn:uuid:1f397b27-62ee-30de-d1d8-bbbe52180109" + }, { + "reference": "urn:uuid:4765f502-af4a-df80-ffa8-f2bca6428323" + } ], + "recorded": "2025-05-18T08:41:58.201+01:00", + "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|9999986190", + "display": "Dr. Theodore876 Ankunding277" + }, + "onBehalfOf": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + }, { + "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|9999986190", + "display": "Dr. Theodore876 Ankunding277" + }, + "onBehalfOf": { + "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1faab3d1-2ae5-3110-8e5f-c65b92ca906d", + "display": "FAIRVIEW HOSPITAL" + } + } ] + }, + "request": { + "method": "POST", + "url": "Provenance" + } + } ] +}