Da Vinci Payer Data Exchange
1.0.0 - STU1

This page is part of the Da Vinci Payer Data Exchange (v1.0.0: STU1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: BundleWithProvenance - XML Representation

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<Bundle xmlns="http://hl7.org/fhir">
  <id value="3000002"/>
  <meta>
    <profile value="http://hl7.org/fhir/StructureDefinition/Bundle"/>
  </meta>
  <type value="searchset"/>
  <timestamp value="2020-09-28T23:26:23.217+00:00"/>
  <total value="1"/>
  <entry>
    <fullUrl value="https://example.com/base/MedicationDispense/1000001"/>
    <resource>
      <MedicationDispense>
        <id value="1000001"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><p><b>status</b>: completed</p><p><b>medication</b>: <span title="Codes: {http://hl7.org/fhir/sid/ndc 54458-872-10}">30 TABLET in 1 BLISTER PACK (54458-872-10)</span></p><p><b>subject</b>: <a href="Patient-1.html">Generated Summary: language: en-US; Member Number: https://www.xxxhealthplan.com/fhir/memberidentifier#1234-234-1243-12345678901, Medical record number: 1234-234-1243-12345678901m, Health Plan Identifier: 1234-234-1243-12345678901u, Patient external identifier: 1234-234-1243-12345678901a; active; Johnny Appleseed ; Phone: (410)678-2323; gender: male; birthDate: 1986-01-01; <span title="Codes: {http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}">unknown</span></a></p><h3>Performers</h3><table class="grid"><tr><td>-</td><td><b>Actor</b></td></tr><tr><td>*</td><td><a href="Practitioner-4.html">Generated Summary: National Provider Identifier: 874635264; Susan Smith ; Phone: 3015551234; gender: female; birthDate: 1965-11-15</a></td></tr></table><p><b>location</b>: <a href="Location-5.html">Generated Summary: name: MyFavorite Pharmacy</a></p><p><b>type</b>: <span title="Codes: {http://terminology.hl7.org/CodeSystem/v3-ActCode RF}">Refill</span></p><p><b>quantity</b>: 60</p><p><b>daysSupply</b>: 30</p></div>
        </text>
        <status value="completed"/>
        <medicationCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/sid/ndc"/>
            <code value="54458-872-10"/>
          </coding>
        </medicationCodeableConcept>
        <subject>
          <reference value="Patient/1"/>
        </subject>
        <performer>
          <actor>
            <reference value="Practitioner/4"/>
          </actor>
        </performer>
        <location>
          <reference value="Location/5"/>
        </location>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
            <code value="RF"/>
          </coding>
        </type>
        <quantity>
          <value value="60"/>
        </quantity>
        <daysSupply>
          <value value="30"/>
        </daysSupply>
      </MedicationDispense>
    </resource>
  </entry>
  <entry>
    <fullUrl value="https://example.com/base/Provenance/321000001"/>
    <resource>
      <Provenance>
        <id value="321000001"/>
        <meta>
          <versionId value="1"/>
          <lastUpdated value="2020-09-28T23:26:23.217+00:00"/>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><p><b>target</b>: <a href="#MedicationDispense_1000001">See above (MedicationDispense/1000001)</a></p><p><b>recorded</b>: Jul 12, 2020 6:26:23 PM</p><h3>Agents</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Who</b></td></tr><tr><td>*</td><td><span title="Codes: {http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type transmitter}">Transmitter</span></td><td><a href="Organization-2.html">Generated Summary: language: en-US; National Provider Identifier: 345678; active; name: Payer 1</a></td></tr></table><h3>Entities</h3><table class="grid"><tr><td>-</td><td><b>Extension</b></td><td><b>Role</b></td><td><b>What</b></td></tr><tr><td>*</td><td></td><td>source</td><td><span>No reference available</span></td></tr></table></div>
        </text>
        <target>
          <reference value="MedicationDispense/1000001"/>
        </target>
        <recorded value="2020-07-12T18:26:23.217+00:00"/>
        <agent>
          <type>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type"/>
              <code value="transmitter"/>
              <display value="Transmitter"/>
            </coding>
          </type>
          <who>
            <reference value="Organization/2"/>
          </who>
        </agent>
        <entity>
          <extension
                     url="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/ProvenanceSourceFrom">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/ProvenancePayerDataSource"/>
                <code value="hl7ccda"/>
                <display value="HL7 C-CDA"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <role value="source"/>
          <what>
            <display value="No reference available"/>
          </what>
        </entity>
      </Provenance>
    </resource>
  </entry>
</Bundle>