This page is part of the Da Vinci Clinical Documentation Exchange (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions 
JSON Format: Bundle-cdex-example-transaction
Raw json
{
"resourceType" : "Bundle",
"id" : "cdex-example-transaction",
"meta" : {
"versionId" : "2",
"lastUpdated" : "2019-06-06T23:05:18.000-04:00"
},
"identifier" : {
"system" : "urn:ietf:rfc:3986",
"value" : "urn:uuid:112a9303-8879-4e3e-8f66-c25f113fa8bd"
},
"type" : "transaction",
"entry" : [
{
"fullUrl" : "urn:uuid:2a1bf29c-5847-422f-819f-391de77db463",
"resource" : {
"resourceType" : "Patient",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p>\n <b>Generated Narrative with Details</b>\n </p>\n <p>\n <b>id</b>: example\n \n \n \n </p>\n <p>\n <b>identifier</b>: Medical Record Number = 1032702 (USUAL)\n \n \n \n </p>\n <p>\n <b>active</b>: true\n \n \n \n </p>\n <p>\n <b>name</b>: Amy V. Shaw \n \n \n \n </p>\n <p>\n <b>telecom</b>: ph: 555-555-5555(HOME), amy.shaw@example.com\n \n \n \n </p>\n <p>\n <b>gender</b>: \n \n \n \n </p>\n <p>\n <b>birthsex</b>: Female\n \n \n \n </p>\n <p>\n <b>birthDate</b>: Feb 20, 2007\n \n \n \n </p>\n <p>\n <b>address</b>: 49 Meadow St Mounds OK 74047 US \n \n \n \n </p>\n <p>\n <b>race</b>: White, American Indian or Alaska Native, Asian, Shoshone, Filipino\n \n \n \n </p>\n <p>\n <b>ethnicity</b>: Hispanic or Latino, Dominican, Mexican\n \n \n \n </p>\n </div>"
},
"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" : "ombCategory",
"valueCoding" : {
"system" : "urn:oid:2.16.840.1.113883.6.238",
"code" : "1002-5",
"display" : "American Indian or Alaska Native"
}
},
{
"url" : "ombCategory",
"valueCoding" : {
"system" : "urn:oid:2.16.840.1.113883.6.238",
"code" : "2028-9",
"display" : "Asian"
}
},
{
"url" : "detailed",
"valueCoding" : {
"system" : "urn:oid:2.16.840.1.113883.6.238",
"code" : "1586-7",
"display" : "Shoshone"
}
},
{
"url" : "detailed",
"valueCoding" : {
"system" : "urn:oid:2.16.840.1.113883.6.238",
"code" : "2036-2",
"display" : "Filipino"
}
},
{
"url" : "text",
"valueString" : "Mixed"
}
]
},
{
"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" : "2135-2",
"display" : "Hispanic or Latino"
}
},
{
"url" : "detailed",
"valueCoding" : {
"system" : "urn:oid:2.16.840.1.113883.6.238",
"code" : "2184-0",
"display" : "Dominican"
}
},
{
"url" : "detailed",
"valueCoding" : {
"system" : "urn:oid:2.16.840.1.113883.6.238",
"code" : "2148-5",
"display" : "Mexican"
}
},
{
"url" : "text",
"valueString" : "Hispanic or Latino"
}
]
},
{
"url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
"valueCode" : "F"
}
],
"identifier" : [
{
"use" : "usual",
"system" : "http://hospital.smarthealthit.org",
"value" : "1032702"
}
],
"active" : true,
"name" : [
{
"family" : "Shaw",
"given" : [
"Amy",
"V."
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "555-555-5555",
"use" : "home"
},
{
"system" : "email",
"value" : "amy.shaw@example.com"
}
],
"gender" : "female",
"birthDate" : "2007-02-20",
"address" : [
{
"line" : [
"49 Meadow St"
],
"city" : "Mounds",
"state" : "OK",
"postalCode" : "74047",
"country" : "US"
}
]
},
"request" : {
"method" : "POST",
"url" : "Patient"
}
},
{
"fullUrl" : "urn:uuid:e4bd819d-c246-4791-af55-6f2fb2cf2a7f",
"resource" : {
"resourceType" : "Claim",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Claim\n \n \n </div>"
},
"identifier" : [
{
"system" : "http://happypdocs.com/claim",
"value" : "8612345"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "professional"
}
]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/cdex-example-patient"
},
"created" : "2019-01-02",
"insurer" : {
"reference" : "Organization/cdex-example-payer"
},
"provider" : {
"reference" : "Practitioner/cdex-example-practitioner"
},
"priority" : {
"coding" : [
{
"code" : "normal"
}
]
},
"payee" : {
"type" : {
"coding" : [
{
"code" : "provider"
}
]
}
},
"careTeam" : [
{
"sequence" : 1,
"provider" : {
"reference" : "Practitioner/cdex-example-practitioner"
}
}
],
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"code" : "654456"
}
]
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "Coverage/cdex-example-coverage"
}
}
],
"item" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code" : "1101",
"display" : "Exam, comp, primary"
}
]
},
"servicedDate" : "2018-08-16",
"unitPrice" : {
"value" : 75
},
"net" : {
"value" : 75
}
}
]
},
"request" : {
"method" : "POST",
"url" : "Claim"
}
}
]
}
