Bundle ReferralAuthorizationBundleExample of type collection

Entry 1 - Full URL = http://example.org/fhir/Claim/ReferralAuthorizationExample

Resource Claim:

Generated Narrative

Resource "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: ACTIVE

type: Professional (Claim Type Codes#professional)

use: PREAUTHORIZATION

patient: Patient/SubscriberExample " SMITH"

created: 2005-05-02 11:01:00+0500

insurer: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"

provider: Organization/UMOExample "DR. JOE SMITH CORPORATION"

priority: Normal (Process Priority Codes#normal)

CareTeams

-	Extension	Sequence	Provider
*		1	Practitioner/ReferralPractitionerExample " WATSON"

Diagnoses

-	Extension	Sequence	Diagnosis[x]
*		1	Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-	Sequence	Focal	Coverage
*	1	true	Coverage/InsuranceExample

Items

-	Extension	Sequence	CareTeamSequence	DiagnosisSequence	ProductOrService	Location[x]
*	, , , , , , , , ,	1	1	1	Consultation (1365#3)	11 (CMS Place of Service Codes (POS)#11)

Entry 2 - Full URL = http://example.org/fhir/Organization/UMOExample

Resource Organization:

Generated Narrative

Resource "UMOExample"

Profile: PAS Requestor Organization

identifier: id: 8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

Entry 3 - Full URL = http://example.org/fhir/Organization/InsurerExample

Resource Organization:

Generated Narrative

Resource "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: 789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

Entry 4 - Full URL = http://example.org/fhir/Coverage/InsuranceExample

Resource Coverage:

Generated Narrative

Resource "InsuranceExample"

Profile: PAS Coverage

status: ACTIVE

beneficiary: Patient/SubscriberExample " SMITH"

payor: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"

Entry 5 - Full URL = http://example.org/fhir/Patient/SubscriberExample

Resource Patient:

JOE SMITH Male ( id: 12345678901)

Entry 6 - Full URL = http://example.org/fhir/ServiceRequest/ReferralRequestExample

Resource ServiceRequest:

Generated Narrative

Resource "ReferralRequestExample"

Profile: PAS Service Request

status: ACTIVE

intent: ORDER

code: Consultation (1365#3)

quantity: 1 {visit} (Details: UCUM code {visit} = '{visit}')

subject: Patient/SubscriberExample " SMITH"