Bundle SurgicalRequestBundleExample of type collection

Entry 1 - fullUrl = http://example.org/fhir/Claim/SurgicalAuthorizationRequestExample

Resource Claim:

Profile: PAS Claim

LevelOfServiceCode: Elective

Extension Definition for Claim.encounter for Version 5.0: Encounter: extension = Still a patient; status = planned; class = ambulatory (ActCode#AMB); type = 2; period = 2020-07-02 --> 2020-07-09

ConditionCode

• category: 07
• indicator: true
• code: 09

identifier: http://example.org/PATIENT_EVENT_TRACE_NUMBER/16139462398

status: Active

type: Institutional

use: Preauthorization

patient: JOE SMITH Male, DoB Unknown ( Member Number)

created: 2020-06-24 07:34:00+0500

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

provider: Organization DR. JOE SMITH CORPORATION

priority: Normal

CareTeams

-	Extension	Sequence	Provider
*		1	PractitionerRole: telecom = ph: 4029993456

SupportingInfos

-	Sequence	Category	Timing[x]
*	1	Admission Dates	2020-07-02 --> 2020-07-09

Diagnoses

-	Extension	Sequence	Diagnosis[x]
*		1	Malignant neoplasm of colon, unspecified

Insurances

-	Sequence	Focal	Coverage
*	1	true	Coverage: status = active; subscriberId = 1122334455; relationship = Self

item

ServiceItemRequestType: Admission Review

CertificationType: Initial

ItemTraceNumber: http://example.org/ITEM_TRACE_NUMBER/1122334

AuthorizationNumber: 1122445

AdministrationReferenceNumber: 9988311

sequence: 1

careTeamSequence: 1

diagnosisSequence: 1

category: Surgical

productOrService: Under Venous Grafting Only for Coronary Artery Bypass

location: Inpatient Hospital

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

Resource Organization:

Profile: PAS Requestor Organization

identifier: United States National Provider Identifier/8189991234

active: true

type: X3

name: DR. JOE SMITH CORPORATION

Contacts

-	Address
*	111 1ST STREET SAN DIEGO CA 92101 US

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

Resource Organization:

Profile: PAS Insurer Organization

identifier: United States National Provider Identifier/1234567893

active: true

type: PR

name: MARYLAND CAPITAL INSURANCE COMPANY

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

Resource Coverage:

Profile: PAS Coverage

status: Active

subscriberId: 1122334455

beneficiary: JOE SMITH Male, DoB Unknown ( Member Number)

relationship: Self

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

Resource Patient:

Profile: PAS Subscriber Patient

JOE SMITH Male, DoB Unknown ( Member Number)

---

RU

Entry 6 - fullUrl = http://example.org/fhir/Encounter/SurgicalEncounterExample

Resource Encounter:

Profile: PAS Encounter

PatientStatus: Still a patient

status: Planned

class: ambulatory

type: 2

subject: JOE SMITH Male, DoB Unknown ( Member Number)

Entry 7 - fullUrl = http://example.org/fhir/PractitionerRole/SurgicalPractitionerRoleExample

Resource PractitionerRole:

Profile: PAS PractitionerRole

practitioner: Practitioner SUSAN WATSON

location: Location REFERRAL CLINIC

Entry 8 - fullUrl = http://example.org/fhir/Practitioner/SurgicalPractitionerExample

Resource Practitioner:

Profile: PAS Practitioner

identifier: United States National Provider Identifier/1234567893

name: SUSAN WATSON

Entry 9 - fullUrl = http://example.org/fhir/Location/SurgicalLocationExample

Resource Location:

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US