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

: ExampleMedicationDispenseClaim - JSON Representation

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{
  "resourceType" : "MedicationDispense",
  "id" : "1000001",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2020-07-09T15:26:23.217+00:00",
    "profile" : [
      "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-medicationdispense"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>An attribute to express the refill number of a prescription</b>: 1</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>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/DispenseRefill",
      "valueQuantity" : {
        "value" : 1
      }
    }
  ],
  "status" : "completed",
  "medicationCodeableConcept" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/sid/ndc",
        "code" : "54458-872-10"
      }
    ]
  },
  "subject" : {
    "reference" : "Patient/1"
  },
  "performer" : [
    {
      "actor" : {
        "reference" : "Practitioner/4"
      }
    }
  ],
  "location" : {
    "reference" : "Location/5"
  },
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "RF"
      }
    ]
  },
  "quantity" : {
    "value" : 60
  },
  "daysSupply" : {
    "value" : 30
  }
}