Data Exchange For Quality Measures Implementation Guide
3.1.0 - STU 3.1.0 US

This page is part of the Da Vinci Data Exchange for Quality Measures (DEQM) FHIR IG (v3.1.0: STU 3) 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

: Gaps Bundle Closed Individual MeasureReport01 - XML Representation

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<Bundle xmlns="http://hl7.org/fhir">
  <id value="single-gaps-closed-indv-report01"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-bundle-deqm"/>
  </meta>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:f119bdf2-eeb9-47b2-8dc1-e2068cc3c4ae"/>
  </identifier>
  <type value="document"/>
  <timestamp value="2020-06-30T13:08:53+00:00"/>
  <entry>
    <fullUrl
             value="http://example.org/fhir/gaps/Composition/gaps-composition02"/>
    <resource>
      <Composition>
        <id value="gaps-composition02"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-composition-deqm"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Composition</b><a name="gaps-composition02"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Composition &quot;gaps-composition02&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-gaps-composition-deqm.html">DEQM Gaps In Care Composition Profile</a></p></div><p><b>status</b>: final</p><p><b>type</b>: Gaps in care report <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://loinc.org/">LOINC</a>#96315-7)</span></p><p><b>date</b>: 2020-06-30 01:08:53+0000</p><p><b>author</b>: <a href="#Organization_gaps-organization-reportingvendor">See above (Organization/gaps-organization-reportingvendor)</a></p><p><b>title</b>: Care Gap Report for patient gaps-patient02</p></div>
        </text>
        <status value="final"/>
        <type>
          <coding>
            <system value="http://loinc.org"/>
            <code value="96315-7"/>
            <display value="Gaps in care report"/>
          </coding>
        </type>
        <subject>
          <reference value="Patient/gaps-patient02"/>
        </subject>
        <date value="2020-06-30T13:08:53+00:00"/>
        <author>
          <reference value="Organization/gaps-organization-reportingvendor"/>
        </author>
        <title value="Care Gap Report for patient gaps-patient02"/>
        <section>
          <title value="Colorectal Cancer Screening"/>
          <focus>
            <reference value="MeasureReport/gaps-indv-measurereport03"/>
          </focus>
          <entry>
            <reference value="DetectedIssue/gaps-detectedissue03"/>
          </entry>
        </section>
      </Composition>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://example.org/fhir/gaps/DetectedIssue/gaps-detectedissue03"/>
    <resource>
      <DetectedIssue>
        <id value="gaps-detectedissue03"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: DetectedIssue</b><a name="gaps-detectedissue03"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource DetectedIssue &quot;gaps-detectedissue03&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-gaps-detectedissue-deqm.html">DEQM Gaps In Care Detected Issue Profile</a></p></div><p><b>status</b>: final</p><p><b>code</b>: Caregap <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-v3-ActCode.html">ActCode</a>#CAREGAP)</span></p><p><b>patient</b>: <a href="#Patient_gaps-patient02">See above (Patient/gaps-patient02)</a></p><h3>Evidences</h3><table class="grid"><tr><td>-</td><td><b>Detail</b></td></tr><tr><td>*</td><td><a href="#MeasureReport_gaps-indv-measurereport03">See above (MeasureReport/gaps-indv-measurereport03)</a></td></tr></table></div>
        </text>
        <modifierExtension
                           url="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-gapStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-status"/>
              <code value="closed-gap"/>
            </coding>
          </valueCodeableConcept>
        </modifierExtension>
        <status value="final"/>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
            <code value="CAREGAP"/>
            <display value="Caregap"/>
          </coding>
        </code>
        <patient>
          <reference value="Patient/gaps-patient02"/>
        </patient>
        <evidence>
          <detail>
            <reference value="MeasureReport/gaps-indv-measurereport03"/>
          </detail>
        </evidence>
      </DetectedIssue>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://example.org/fhir/gaps/MeasureReport/gaps-indv-measurereport03"/>
    <resource>
      <MeasureReport>
        <id value="gaps-indv-measurereport03"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"/>
        </meta>
        <text>
          <status value="extensions"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: MeasureReport</b><a name="gaps-indv-measurereport03"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource MeasureReport &quot;gaps-indv-measurereport03&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-indv-measurereport-deqm.html">DEQM Individual MeasureReport Profile</a></p></div><p><b>DEQM Measure Scoring Extension</b>: Proportion <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-measure-scoring.html">MeasureScoring</a>#proportion)</span></p><p><b>DEQM Certification Identifier Extension</b>: id: 0015HQN9BD3304E</p><p><b>DEQM Reporting Vendor Extension</b>: <a href="#Organization_gaps-organization-reportingvendor">See above (Organization/gaps-organization-reportingvendor)</a></p><p><b>status</b>: complete</p><p><b>type</b>: individual</p><p><b>measure</b>: <a href="Measure-measure-exm130-example.html">Colorectal Cancer Screening Measure</a></p><p><b>subject</b>: <a href="#Patient_gaps-patient02">See above (Patient/gaps-patient02)</a></p><p><b>date</b>: 2020-06-30 01:08:52+0000</p><p><b>reporter</b>: <a href="Organization-organization01.html">Organization/organization01</a> &quot;DaVinciHospital01&quot;</p><p><b>period</b>: 2020-01-01 --&gt; 2020-12-31</p><p><b>improvementNotation</b>: Increased score indicates improvement <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-measure-improvement-notation.html">MeasureImprovementNotation</a>#increase)</span></p><blockquote><p><b>group</b></p><blockquote><p><b>population</b></p><p><b>code</b>: Initial Population <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-measure-population.html">MeasurePopulationType</a>#initial-population)</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: Numerator <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-measure-population.html">MeasurePopulationType</a>#numerator)</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: Denominator <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-measure-population.html">MeasurePopulationType</a>#denominator)</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: Denominator Exclusion <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-measure-population.html">MeasurePopulationType</a>#denominator-exclusion)</span></p><p><b>count</b>: 0</p></blockquote><p><b>measureScore</b>: 1.0</p></blockquote><p><b>evaluatedResource</b>: </p><ul><li><a href="#Encounter_gaps-encounter02">See above (Encounter/gaps-encounter02)</a></li><li><a href="#Patient_gaps-patient02">See above (Patient/gaps-patient02)</a></li><li><a href="#Procedure_gaps-procedure01">See above (Procedure/gaps-procedure01)</a></li></ul></div>
        </text>
        <extension
                   url="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
              <code value="proportion"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-certificationIdentifier">
          <valueIdentifier>
            <system value="urn:oid:2.16.840.1.113883.3.2074.1"/>
            <value value="0015HQN9BD3304E"/>
          </valueIdentifier>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-reportingVendor">
          <valueReference>
            <reference
                       value="Organization/gaps-organization-reportingvendor"/>
          </valueReference>
        </extension>
        <status value="complete"/>
        <type value="individual"/>
        <measure
                 value="http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm130-example"/>
        <subject>
          <reference value="Patient/gaps-patient02"/>
        </subject>
        <date value="2020-06-30T13:08:52+00:00"/>
        <reporter>
          <reference value="Organization/organization01"/>
        </reporter>
        <period>
          <start value="2020-01-01"/>
          <end value="2020-12-31"/>
        </period>
        <improvementNotation>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
            <code value="increase"/>
          </coding>
        </improvementNotation>
        <group id="group-exm130">
          <population>
            <code>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/measure-population"/>
                <code value="initial-population"/>
                <display value="Initial Population"/>
              </coding>
            </code>
            <count value="1"/>
          </population>
          <population>
            <code>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/measure-population"/>
                <code value="numerator"/>
                <display value="Numerator"/>
              </coding>
            </code>
            <count value="1"/>
          </population>
          <population>
            <code>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/measure-population"/>
                <code value="denominator"/>
                <display value="Denominator"/>
              </coding>
            </code>
            <count value="1"/>
          </population>
          <population>
            <code>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/measure-population"/>
                <code value="denominator-exclusion"/>
                <display value="Denominator Exclusion"/>
              </coding>
            </code>
            <count value="0"/>
          </population>
          <measureScore>
            <value value="1.0"/>
          </measureScore>
        </group>
        <evaluatedResource>
          <extension
                     url="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference">
            <valueString value="initial-population"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference">
            <valueString value="denominator"/>
          </extension>
          <reference value="Encounter/gaps-encounter02"/>
        </evaluatedResource>
        <evaluatedResource>
          <extension
                     url="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference">
            <valueString value="initial-population"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference">
            <valueString value="denominator"/>
          </extension>
          <reference value="Patient/gaps-patient02"/>
        </evaluatedResource>
        <evaluatedResource>
          <extension
                     url="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference">
            <valueString value="numerator"/>
          </extension>
          <reference value="Procedure/gaps-procedure01"/>
        </evaluatedResource>
      </MeasureReport>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/fhir/gaps/Encounter/gaps-encounter02"/>
    <resource>
      <Encounter>
        <id value="gaps-encounter02"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Encounter</b><a name="gaps-encounter02"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Encounter &quot;gaps-encounter02&quot; </p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a></p></div><p><b>status</b>: finished</p><p><b>class</b>: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')</p><p><b>type</b>: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-CPT.html">Current Procedural Terminology (CPT®)</a>#99201)</span></p><p><b>subject</b>: <a href="#Patient_gaps-patient02">See above (Patient/gaps-patient02)</a></p><p><b>period</b>: 2020-03-05 07:00:00+0000 --&gt; 2020-03-05 10:00:00+0000</p></div>
        </text>
        <status value="finished"/>
        <class>
          <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
          <code value="AMB"/>
          <display value="ambulatory"/>
        </class>
        <type>
          <coding>
            <system value="http://www.ama-assn.org/go/cpt"/>
            <code value="99201"/>
            <display
                     value="Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family."/>
          </coding>
        </type>
        <subject>
          <reference value="Patient/gaps-patient02"/>
        </subject>
        <period>
          <start value="2020-03-05T07:00:00-00:00"/>
          <end value="2020-03-05T10:00:00-00:00"/>
        </period>
      </Encounter>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/fhir/gaps/Procedure/gaps-procedure01"/>
    <resource>
      <Procedure>
        <id value="gaps-procedure01"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
        </meta>
        <text>
          <status value="extensions"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Procedure</b><a name="gaps-procedure01"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Procedure &quot;gaps-procedure01&quot; </p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a></p></div><p><b>QICoreNotDoneRecorded</b>: 2018-09-10 09:00:00+0000</p><p><b>status</b>: completed</p><p><b>code</b>: Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-CPT.html">Current Procedural Terminology (CPT®)</a>#45384)</span></p><p><b>subject</b>: <a href="#Patient_gaps-patient02">See above (Patient/gaps-patient02)</a></p><p><b>performed</b>: 2018-09-10 08:00:00+0000 --&gt; 2018-09-10 09:00:00+0000</p></div>
        </text>
        <extension
                   url="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded">
          <valueDateTime value="2018-09-10T09:00:00-00:00"/>
        </extension>
        <status value="completed"/>
        <code>
          <coding>
            <system value="http://www.ama-assn.org/go/cpt"/>
            <code value="45384"/>
            <display
                     value="Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique"/>
          </coding>
        </code>
        <subject>
          <reference value="Patient/gaps-patient02"/>
        </subject>
        <performedPeriod>
          <start value="2018-09-10T08:00:00-00:00"/>
          <end value="2018-09-10T09:00:00-00:00"/>
        </performedPeriod>
      </Procedure>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/fhir/gaps/Patient/gaps-patient02"/>
    <resource>
      <Patient>
        <id value="gaps-patient02"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
        </meta>
        <text>
          <status value="extensions"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Patient</b><a name="gaps-patient02"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Patient &quot;gaps-patient02&quot; </p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a></p></div><blockquote><p><b>US Core Race Extension</b></p><p><b>value</b>: Asian (Details: urn:oid:2.16.840.1.113883.6.238 code 2028-9 = 'Asian', stated as 'Asian')</p><p><b>value</b>: Asian</p></blockquote><blockquote><p><b>US Core Ethnicity Extension</b></p><p><b>value</b>: Hispanic or Latino (Details: urn:oid:2.16.840.1.113883.6.238 code 2135-2 = 'Hispanic or Latino', stated as 'Hispanic or Latino')</p><p><b>value</b>: Hispanic or Latino</p></blockquote><p><b>identifier</b>: Medical Record Number: 999996992 (use: USUAL)</p><p><b>name</b>: Thomas Ludwich </p><p><b>gender</b>: male</p><p><b>birthDate</b>: 1957-01-01</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="2028-9"/>
              <display value="Asian"/>
            </valueCoding>
          </extension>
          <extension url="text">
            <valueString value="Asian"/>
          </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="text">
            <valueString value="Hispanic or Latino"/>
          </extension>
        </extension>
        <identifier>
          <use value="usual"/>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="MR"/>
              <display value="Medical Record Number"/>
            </coding>
          </type>
          <system value="http://hospital.smarthealthit.org"/>
          <value value="999996992"/>
        </identifier>
        <name>
          <family value="Ludwich"/>
          <given value="Thomas"/>
        </name>
        <gender value="male"/>
        <birthDate value="1957-01-01"/>
      </Patient>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://example.org/fhir/gaps/Organization/gaps-organization-reportingvendor"/>
    <resource>
      <Organization>
        <id value="gaps-organization-reportingvendor"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Organization</b><a name="gaps-organization-reportingvendor"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Organization &quot;gaps-organization-reportingvendor&quot; </p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-organization.html">QICoreOrganization</a></p></div><p><b>identifier</b>: Tax ID number: 123446789 (use: OFFICIAL)</p><p><b>active</b>: true</p><p><b>type</b>: Payer <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-organization-type.html">Organization type</a>#pay)</span></p><p><b>name</b>: GapsReportingVendor01</p><p><b>telecom</b>: ph: (+1) 401-545-1212</p><p><b>address</b>: 13 Drive Street Cityplace MA 01101 USA </p></div>
        </text>
        <identifier>
          <use value="official"/>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="TAX"/>
              <display value="Tax ID number"/>
            </coding>
          </type>
          <system value="urn:oid:2.16.840.1.113883.4.4"/>
          <value value="123446789"/>
          <assigner>
            <display value="www.irs.gov"/>
          </assigner>
        </identifier>
        <active value="true"/>
        <type>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/organization-type"/>
            <code value="pay"/>
            <display value="Payer"/>
          </coding>
        </type>
        <name value="GapsReportingVendor01"/>
        <telecom>
          <system value="phone"/>
          <value value="(+1) 401-545-1212"/>
        </telecom>
        <address>
          <line value="13 Drive Street"/>
          <city value="Cityplace"/>
          <state value="MA"/>
          <postalCode value="01101"/>
          <country value="USA"/>
        </address>
      </Organization>
    </resource>
  </entry>
</Bundle>