Da Vinci Prior Authorization Support (PAS) FHIR IG
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This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0-preview: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.1. For a full list of available versions, see the Directory of published versions

: Surgical Admission Request Bundle Example - XML Representation

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<Bundle xmlns="http://hl7.org/fhir">
  <id value="SurgicalRequestBundleExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle"/>
  </meta>
  <identifier>
    <system value="http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER"/>
    <value value="16139462398"/>
  </identifier>
  <type value="collection"/>
  <timestamp value="2020-06-24T07:34:00+05:00"/>
  <entry>
    <fullUrl
             value="http://example.org/fhir/Claim/SurgicalAuthorizationRequestExample"/>
    <resource>
      <Claim>
        <id value="SurgicalAuthorizationRequestExample"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"/>
        </meta>
        <text>
          <status value="extensions"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Claim_SurgicalAuthorizationRequestExample"> </a><p class="res-header-id"><b>Generated Narrative: Claim SurgicalAuthorizationRequestExample</b></p><a name="SurgicalAuthorizationRequestExample"> </a><a name="hcSurgicalAuthorizationRequestExample"> </a><a name="SurgicalAuthorizationRequestExample-en-US"> </a><p><b>LevelOfServiceCode</b>: <span title="Codes:{https://codesystem.x12.org/005010/1338 E}">Elective</span></p><p><b>Extension Definition for Claim.encounter for Version 5.0</b>: <a href="Encounter-SurgicalEncounterExample.html">Encounter: extension = Still a patient; status = planned; class = ambulatory (ActCode#AMB); type = 2; period = 2020-07-02 --&gt; 2020-07-09</a></p><blockquote><p><b>ConditionCode</b></p><ul><li>category: <span title="Codes:{https://codesystem.x12.org/005010/1136 07}">07</span></li><li>indicator: true</li><li>code: <span title="Codes:{https://codesystem.x12.org/005010/1321 09}">09</span></li></ul></blockquote><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/16139462398</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}">Institutional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href="Patient-SubscriberExample.html">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>created</b>: 2020-06-24 07:34:00+0500</p><p><b>insurer</b>: <a href="Organization-InsurerExample.html">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>provider</b>: <a href="Organization-UMOExample.html">Organization DR. JOE SMITH CORPORATION</a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><h3>CareTeams</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style="display: none">*</td><td/><td>1</td><td><a href="PractitionerRole-SurgicalPractitionerRoleExample.html">PractitionerRole</a></td></tr></table><h3>SupportingInfos</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Timing[x]</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><span title="Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes admissionDates}">Admission Dates</span></td><td>2020-07-02 --&gt; 2020-07-09</td></tr></table><h3>Diagnoses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style="display: none">*</td><td/><td>1</td><td><span title="Codes:{http://hl7.org/fhir/sid/icd-10-cm C18.9}">Malignant neoplasm of colon, unspecified</span></td></tr></table><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>true</td><td><a href="Coverage-InsuranceExample.html">Coverage: status = active; subscriberId = 1122334455; relationship = Self</a></td></tr></table><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title="Codes:{https://codesystem.x12.org/005010/1525 AR}">Admission Review</span></p><p><b>CertificationType</b>: <span title="Codes:{https://codesystem.x12.org/005010/1322 I}">Initial</span></p><p><b>ItemTraceNumber</b>: <code>http://example.org/ITEM_TRACE_NUMBER</code>/1122334</p><p><b>AuthorizationNumber</b>: 1122445</p><p><b>AdministrationReferenceNumber</b>: 9988311</p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>diagnosisSequence</b>: 1</p><p><b>category</b>: <span title="Codes:{https://codesystem.x12.org/005010/1365 2}">Surgical</span></p><p><b>productOrService</b>: <span title="Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets 33510}">Under Venous Grafting Only for Coronary Artery Bypass</span></p><p><b>location</b>: <span title="Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 21}">21</span></p></blockquote></div>
        </text>
        <extension
                   url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode">
          <valueCodeableConcept>
            <coding>
              <system value="https://codesystem.x12.org/005010/1338"/>
              <code value="E"/>
              <display value="Elective"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter">
          <valueReference>🔗 
            <reference value="Encounter/SurgicalEncounterExample"/>
          </valueReference>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode">
          <extension url="category">
            <valueCodeableConcept>
              <coding>
                <system value="https://codesystem.x12.org/005010/1136"/>
                <code value="07"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <extension url="indicator">
            <valueBoolean value="true"/>
          </extension>
          <extension url="code">
            <valueCodeableConcept>
              <coding>
                <system value="https://codesystem.x12.org/005010/1321"/>
                <code value="09"/>
              </coding>
            </valueCodeableConcept>
          </extension>
        </extension>
        <identifier>
          <system value="http://example.org/PATIENT_EVENT_TRACE_NUMBER"/>
          <value value="16139462398"/>
          <assigner>
            <identifier>
              <system value="http://example.org/USER_ASSIGNED"/>
              <value value="3030240928"/>
            </identifier>
          </assigner>
        </identifier>
        <status value="active"/>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
            <code value="institutional"/>
          </coding>
        </type>
        <use value="preauthorization"/>
        <patient>🔗 
          <reference value="Patient/SubscriberExample"/>
        </patient>
        <created value="2020-06-24T07:34:00+05:00"/>
        <insurer>🔗 
          <reference value="Organization/InsurerExample"/>
        </insurer>
        <provider>🔗 
          <reference value="Organization/UMOExample"/>
        </provider>
        <priority>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/processpriority"/>
            <code value="normal"/>
          </coding>
        </priority>
        <careTeam>
          <extension
                     url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope">
            <valueBoolean value="true"/>
          </extension>
          <sequence value="1"/>
          <provider>🔗 
            <reference
                       value="PractitionerRole/SurgicalPractitionerRoleExample"/>
          </provider>
        </careTeam>
        <supportingInfo>
          <sequence value="1"/>
          <category>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
              <code value="admissionDates"/>
            </coding>
          </category>
          <timingPeriod>
            <start value="2020-07-02"/>
            <end value="2020-07-09"/>
          </timingPeriod>
        </supportingInfo>
        <diagnosis>
          <extension
                     url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate">
            <valueDate value="2020-06-24"/>
          </extension>
          <sequence value="1"/>
          <diagnosisCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/sid/icd-10-cm"/>
              <code value="C18.9"/>
            </coding>
          </diagnosisCodeableConcept>
        </diagnosis>
        <insurance>
          <sequence value="1"/>
          <focal value="true"/>
          <coverage>🔗 
            <reference value="Coverage/InsuranceExample"/>
          </coverage>
        </insurance>
        <item>
          <extension
                     url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType">
            <valueCodeableConcept>
              <coding>
                <system value="https://codesystem.x12.org/005010/1525"/>
                <code value="AR"/>
                <display value="Admission Review"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType">
            <valueCodeableConcept>
              <coding>
                <system value="https://codesystem.x12.org/005010/1322"/>
                <code value="I"/>
                <display value="Initial"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber">
            <valueIdentifier>
              <system value="http://example.org/ITEM_TRACE_NUMBER"/>
              <value value="1122334"/>
            </valueIdentifier>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber">
            <valueString value="1122445"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber">
            <valueString value="9988311"/>
          </extension>
          <sequence value="1"/>
          <careTeamSequence value="1"/>
          <diagnosisSequence value="1"/>
          <category>
            <coding>
              <system value="https://codesystem.x12.org/005010/1365"/>
              <code value="2"/>
              <display value="Surgical"/>
            </coding>
          </category>
          <productOrService>
            <coding>
              <system
                      value="http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"/>
              <code value="33510"/>
              <display
                       value="Under Venous Grafting Only for Coronary Artery Bypass"/>
            </coding>
          </productOrService>
          <locationCodeableConcept>
            <coding>
              <system
                      value="https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"/>
              <code value="21"/>
            </coding>
          </locationCodeableConcept>
        </item>
      </Claim>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/fhir/Organization/UMOExample"/>
    <resource>
      <Organization>
        <id value="UMOExample"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_UMOExample"> </a><p class="res-header-id"><b>Generated Narrative: Organization UMOExample</b></p><a name="UMOExample"> </a><a name="hcUMOExample"> </a><a name="UMOExample-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.3.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/8189991234</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{https://codesystem.x12.org/005010/98 X3}">X3</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>
        </text>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="8189991234"/>
        </identifier>
        <active value="true"/>
        <type>
          <coding>
            <system value="https://codesystem.x12.org/005010/98"/>
            <code value="X3"/>
          </coding>
        </type>
        <name value="DR. JOE SMITH CORPORATION"/>
        <address>
          <line value="111 1ST STREET"/>
          <city value="SAN DIEGO"/>
          <state value="CA"/>
          <postalCode value="92101"/>
          <country value="US"/>
        </address>
      </Organization>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/fhir/Organization/InsurerExample"/>
    <resource>
      <Organization>
        <id value="InsurerExample"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_InsurerExample"> </a><p class="res-header-id"><b>Generated Narrative: Organization InsurerExample</b></p><a name="InsurerExample"> </a><a name="hcInsurerExample"> </a><a name="InsurerExample-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.3.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/1234567893</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{https://codesystem.x12.org/005010/98 PR}">PR</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>
        </text>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="1234567893"/>
        </identifier>
        <active value="true"/>
        <type>
          <coding>
            <system value="https://codesystem.x12.org/005010/98"/>
            <code value="PR"/>
          </coding>
        </type>
        <name value="MARYLAND CAPITAL INSURANCE COMPANY"/>
      </Organization>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/fhir/Coverage/InsuranceExample"/>
    <resource>
      <Coverage>
        <id value="InsuranceExample"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Coverage_InsuranceExample"> </a><p class="res-header-id"><b>Generated Narrative: Coverage InsuranceExample</b></p><a name="InsuranceExample"> </a><a name="hcInsuranceExample"> </a><a name="InsuranceExample-en-US"> </a><p><b>status</b>: Active</p><p><b>subscriberId</b>: 1122334455</p><p><b>beneficiary</b>: <a href="Patient-SubscriberExample.html">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}, {https://codesystem.x12.org/005010/1069 18}">Self</span></p><p><b>payor</b>: <a href="Organization-InsurerExample.html">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p></div>
        </text>
        <status value="active"/>
        <subscriberId value="1122334455"/>
        <beneficiary>🔗 
          <reference value="Patient/SubscriberExample"/>
        </beneficiary>
        <relationship>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
            <code value="self"/>
          </coding>
          <coding>
            <system value="https://codesystem.x12.org/005010/1069"/>
            <code value="18"/>
          </coding>
        </relationship>
        <payor>🔗 
          <reference value="Organization/InsurerExample"/>
        </payor>
      </Coverage>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/fhir/Patient/SubscriberExample"/>
    <resource>
      <Patient>
        <id value="SubscriberExample"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_SubscriberExample"> </a><p class="res-header-id"><b>Generated Narrative: Patient SubscriberExample</b></p><a name="SubscriberExample"> </a><a name="hcSubscriberExample"> </a><a name="SubscriberExample-en-US"> </a><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="A patient's military status."><a href="StructureDefinition-extension-militaryStatus.html"/></td><td colspan="3"><span title="Codes:{https://codesystem.x12.org/005010/584 RU}">RU</span></td></tr></table></div>
        </text>
        <extension
                   url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus">
          <valueCodeableConcept>
            <coding>
              <system value="https://codesystem.x12.org/005010/584"/>
              <code value="RU"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <identifier>
          <system value="http://example.org/MIN"/>
          <value value="12345678901"/>
        </identifier>
        <name>
          <family value="SMITH"/>
          <given value="JOE"/>
        </name>
        <gender value="male"/>
      </Patient>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://example.org/fhir/Encounter/SurgicalEncounterExample"/>
    <resource>
      <Encounter>
        <id value="SurgicalEncounterExample"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter"/>
        </meta>
        <text>
          <status value="extensions"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Encounter_SurgicalEncounterExample"> </a><p class="res-header-id"><b>Generated Narrative: Encounter SurgicalEncounterExample</b></p><a name="SurgicalEncounterExample"> </a><a name="hcSurgicalEncounterExample"> </a><a name="SurgicalEncounterExample-en-US"> </a><p><b>PatientStatus</b>: <span title="Codes:{https://www.nubc.org/CodeSystem/PatDischargeStatus 30}">Still a patient</span></p><p><b>status</b>: Planned</p><p><b>class</b>: <a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-AMB">ActCode</a> AMB: ambulatory</p><p><b>type</b>: <span title="Codes:{https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit 2}">2</span></p><p><b>subject</b>: <a href="Patient-SubscriberExample.html">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>period</b>: 2020-07-02 --&gt; 2020-07-09</p><h3>Hospitalizations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>AdmitSource</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{https://www.nubc.org/CodeSystem/PointOfOrigin 5}">5</span></td></tr></table></div>
        </text>
        <extension
                   url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-patientStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="https://www.nubc.org/CodeSystem/PatDischargeStatus"/>
              <code value="30"/>
              <display value="Still a patient"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <status value="planned"/>
        <class>
          <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
          <code value="AMB"/>
        </class>
        <type>
          <coding>
            <system
                    value="https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit"/>
            <code value="2"/>
          </coding>
        </type>
        <subject>🔗 
          <reference value="Patient/SubscriberExample"/>
        </subject>
        <period>
          <start value="2020-07-02"/>
          <end value="2020-07-09"/>
        </period>
        <hospitalization>
          <admitSource>
            <coding>
              <system value="https://www.nubc.org/CodeSystem/PointOfOrigin"/>
              <code value="5"/>
            </coding>
          </admitSource>
        </hospitalization>
      </Encounter>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://example.org/fhir/PractitionerRole/SurgicalPractitionerRoleExample"/>
    <resource>
      <PractitionerRole>
        <id value="SurgicalPractitionerRoleExample"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="PractitionerRole_SurgicalPractitionerRoleExample"> </a><p class="res-header-id"><b>Generated Narrative: PractitionerRole SurgicalPractitionerRoleExample</b></p><a name="SurgicalPractitionerRoleExample"> </a><a name="hcSurgicalPractitionerRoleExample"> </a><a name="SurgicalPractitionerRoleExample-en-US"> </a><p><b>practitioner</b>: <a href="Practitioner-ReferralPractitionerExample.html">Practitioner SUSAN WATSON </a></p><p><b>location</b>: <a href="Location-ReferralLocationExample.html">Location REFERRAL CLINIC</a></p></div>
        </text>
        <practitioner>🔗 
          <reference value="Practitioner/ReferralPractitionerExample"/>
        </practitioner>
        <location>🔗 
          <reference value="Location/ReferralLocationExample"/>
        </location>
      </PractitionerRole>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://example.org/fhir/Practitioner/SurgicalPractitionerExample"/>
    <resource>
      <Practitioner>
        <id value="SurgicalPractitionerExample"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_SurgicalPractitionerExample"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner SurgicalPractitionerExample</b></p><a name="SurgicalPractitionerExample"> </a><a name="hcSurgicalPractitionerExample"> </a><a name="SurgicalPractitionerExample-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.3.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/1234567893</p><p><b>name</b>: SUSAN WATSON </p><p><b>telecom</b>: ph: 4029993456</p></div>
        </text>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="1234567893"/>
        </identifier>
        <name>
          <family value="WATSON"/>
          <given value="SUSAN"/>
        </name>
        <telecom>
          <system value="phone"/>
          <value value="4029993456"/>
        </telecom>
      </Practitioner>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://example.org/fhir/Location/SurgicalLocationExample"/>
    <resource>
      <Location>
        <id value="SurgicalLocationExample"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Location_SurgicalLocationExample"> </a><p class="res-header-id"><b>Generated Narrative: Location SurgicalLocationExample</b></p><a name="SurgicalLocationExample"> </a><a name="hcSurgicalLocationExample"> </a><a name="SurgicalLocationExample-en-US"> </a><p><b>name</b>: REFERRAL CLINIC</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>
        </text>
        <name value="REFERRAL CLINIC"/>
        <address>
          <line value="111 1ST STREET"/>
          <city value="SAN DIEGO"/>
          <state value="CA"/>
          <postalCode value="92101"/>
          <country value="US"/>
        </address>
      </Location>
    </resource>
  </entry>
</Bundle>