Generated Narrative: Bundle ReferralAuthorizationBundleExample

Bundle ReferralAuthorizationBundleExample of type collection

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

Resource Claim:

Generated Narrative: Claim ReferralAuthorizationExample

LevelOfServiceCode: Urgent

identifier: http://example.org/PATIENT_EVENT_TRACE_NUMBER/111099

status: Active

type: Professional

use: Preauthorization

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

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

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

provider: Organization DR. JOE SMITH CORPORATION

priority: Normal

CareTeams

-	Extension	Sequence	Provider
*		1	PractitionerRole

Diagnoses

-	Extension	Sequence	Diagnosis[x]
*		1	Chronic pain syndrome

Insurances

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

item

ServiceItemRequestType: Specialty Care Review

CertificationType: Initial

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

AuthorizationNumber: 1122445

AdministrationReferenceNumber: 9988311

RequestedService: ServiceRequest Consultation

EPSDTIndicator: false

NursingHomeResidentialStatus: Newly Admitted

NursingHomeLevelOfCare: Intermediate Care Facility (ICF)

RevenueUnitRateLimit: 100

sequence: 1

careTeamSequence: 1

diagnosisSequence: 1

category: Consultation

productOrService: Consultation

location: 11

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

Resource Organization:

Generated Narrative: Organization UMOExample

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:

Generated Narrative: Organization InsurerExample

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:

Generated Narrative: Coverage InsuranceExample

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:

Generated Narrative: Patient SubscriberExample

JOE SMITH Male, DoB Unknown ( Member Number)

---

RU

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

Resource ServiceRequest:

Generated Narrative: ServiceRequest ReferralRequestExample

status: Active

intent: Order

code: No display for ServiceRequest.code (concept: Consultation)

quantity: 1 visit (Details: UCUM code1 = '1')

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

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

Resource PractitionerRole:

Generated Narrative: PractitionerRole ReferralPractitionerRoleExample

practitioner: Practitioner SUSAN WATSON

location: Location REFERRAL CLINIC

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

Resource Practitioner:

Generated Narrative: Practitioner ReferralPractitionerExample

identifier: United States National Provider Identifier/1234567893

name: SUSAN WATSON

telecom: ph: 4029993456

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

Resource Location:

Generated Narrative: Location ReferralLocationExample

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US