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

• Content
• XML
• JSON

XML Format: Bundle-cdex-example-transaction

Raw xml

<Bundle xmlns="http://hl7.org/fhir">
  <id value="cdex-example-transaction"/>
  <meta>
    <versionId value="2"/>
    <lastUpdated value="2019-06-06T23:05:18.000-04:00"/>
  </meta>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:112a9303-8879-4e3e-8f66-c25f113fa8bd"/>
  </identifier>
  <type value="transaction"/>
  <entry>
    <fullUrl value="urn:uuid:2a1bf29c-5847-422f-819f-391de77db463"/>
    <resource>
      <Patient>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">
                        <p>
                            <b>Generated Narrative with Details</b>
                        </p>
                        <p>
                            <b>id</b>: example
                     
                  
                        
                        </p>
                        <p>
                            <b>identifier</b>: Medical Record Number = 1032702 (USUAL)
                     
                  
                        
                        </p>
                        <p>
                            <b>active</b>: true
                     
                  
                        
                        </p>
                        <p>
                            <b>name</b>: Amy V. Shaw 
                     
                  
                        
                        </p>
                        <p>
                            <b>telecom</b>: ph: 555-555-5555(HOME), amy.shaw@example.com
                     
                  
                        
                        </p>
                        <p>
                            <b>gender</b>: 
                     
                  
                        
                        </p>
                        <p>
                            <b>birthsex</b>: Female
                     
                  
                        
                        </p>
                        <p>
                            <b>birthDate</b>: Feb 20, 2007
                     
                  
                        
                        </p>
                        <p>
                            <b>address</b>: 49 Meadow St Mounds OK 74047 US 
                     
                  
                        
                        </p>
                        <p>
                            <b>race</b>: White, American Indian or Alaska Native, Asian, Shoshone, Filipino
                     
                  
                        
                        </p>
                        <p>
                            <b>ethnicity</b>: Hispanic or Latino, Dominican, Mexican
                     
                  
                        
                        </p>
                    </div>
        </text>
        <extension
                   url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-race">
          <extension url="ombCategory">
            <valueCoding>
              <system value="urn:oid:2.16.840.1.113883.6.238"/>
              <code value="2106-3"/>
              <display value="White"/>
            </valueCoding>
          </extension>
          <extension url="ombCategory">
            <valueCoding>
              <system value="urn:oid:2.16.840.1.113883.6.238"/>
              <code value="1002-5"/>
              <display value="American Indian or Alaska Native"/>
            </valueCoding>
          </extension>
          <extension url="ombCategory">
            <valueCoding>
              <system value="urn:oid:2.16.840.1.113883.6.238"/>
              <code value="2028-9"/>
              <display value="Asian"/>
            </valueCoding>
          </extension>
          <extension url="detailed">
            <valueCoding>
              <system value="urn:oid:2.16.840.1.113883.6.238"/>
              <code value="1586-7"/>
              <display value="Shoshone"/>
            </valueCoding>
          </extension>
          <extension url="detailed">
            <valueCoding>
              <system value="urn:oid:2.16.840.1.113883.6.238"/>
              <code value="2036-2"/>
              <display value="Filipino"/>
            </valueCoding>
          </extension>
          <extension url="text">
            <valueString value="Mixed"/>
          </extension>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity">
          <extension url="ombCategory">
            <valueCoding>
              <system value="urn:oid:2.16.840.1.113883.6.238"/>
              <code value="2135-2"/>
              <display value="Hispanic or Latino"/>
            </valueCoding>
          </extension>
          <extension url="detailed">
            <valueCoding>
              <system value="urn:oid:2.16.840.1.113883.6.238"/>
              <code value="2184-0"/>
              <display value="Dominican"/>
            </valueCoding>
          </extension>
          <extension url="detailed">
            <valueCoding>
              <system value="urn:oid:2.16.840.1.113883.6.238"/>
              <code value="2148-5"/>
              <display value="Mexican"/>
            </valueCoding>
          </extension>
          <extension url="text">
            <valueString value="Hispanic or Latino"/>
          </extension>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex">
          <valueCode value="F"/>
        </extension>
        <identifier>
          <use value="usual"/>
          <system value="http://hospital.smarthealthit.org"/>
          <value value="1032702"/>
        </identifier>
        <active value="true"/>
        <name>
          <family value="Shaw"/>
          <given value="Amy"/>
          <given value="V."/>
        </name>
        <telecom>
          <system value="phone"/>
          <value value="555-555-5555"/>
          <use value="home"/>
        </telecom>
        <telecom>
          <system value="email"/>
          <value value="amy.shaw@example.com"/>
        </telecom>
        <gender value="female"/>
        <birthDate value="2007-02-20"/>
        <address>
          <line value="49 Meadow St"/>
          <city value="Mounds"/>
          <state value="OK"/>
          <postalCode value="74047"/>
          <country value="US"/>
        </address>
      </Patient>
    </resource>
    <request>
      <method value="POST"/>
      <url value="Patient"/>
    </request>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:e4bd819d-c246-4791-af55-6f2fb2cf2a7f"/>
    <resource>
      <Claim>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Claim
               
                    
                    </div>
        </text>
        <identifier>
          <system value="http://happypdocs.com/claim"/>
          <value value="8612345"/>
        </identifier>
        <status value="active"/>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
            <code value="professional"/>
          </coding>
        </type>
        <use value="claim"/>
        <patient>
          <reference value="Patient/cdex-example-patient"/>
        </patient>
        <created value="2019-01-02"/>
        <insurer>
          <reference value="Organization/cdex-example-payer"/>
        </insurer>
        <provider>
          <reference value="Practitioner/cdex-example-practitioner"/>
        </provider>
        <priority>
          <coding>
            <code value="normal"/>
          </coding>
        </priority>
        <payee>
          <type>
            <coding>
              <code value="provider"/>
            </coding>
          </type>
        </payee>
        <careTeam>
          <sequence value="1"/>
          <provider>
            <reference value="Practitioner/cdex-example-practitioner"/>
          </provider>
        </careTeam>
        <diagnosis>
          <sequence value="1"/>
          <diagnosisCodeableConcept>
            <coding>
              <code value="654456"/>
            </coding>
          </diagnosisCodeableConcept>
        </diagnosis>
        <insurance>
          <sequence value="1"/>
          <focal value="true"/>
          <coverage>
            <reference value="Coverage/cdex-example-coverage"/>
          </coverage>
        </insurance>
        <item>
          <sequence value="1"/>
          <productOrService>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/ex-USCLS"/>
              <code value="1101"/>
              <display value="Exam, comp, primary"/>
            </coding>
          </productOrService>
          <servicedDate value="2018-08-16"/>
          <unitPrice>
            <value value="75"/>
          </unitPrice>
          <net>
            <value value="75"/>
          </net>
        </item>
      </Claim>
    </resource>
    <request>
      <method value="POST"/>
      <url value="Claim"/>
    </request>
  </entry>
</Bundle>