Da Vinci - Payer Coverage Decision Exchange (PCDE)
1.0.0 - STU 1
Da Vinci - Payer Coverage Decision Exchange (PCDE)
1.0.0 - STU 1
This page is part of the Da Vinci Payer Coverage Decision Exchange (PCDE) FHIR IG (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions 
@prefix fhir: <http://hl7.org/fhir/> .
@prefix loinc: <http://loinc.org/rdf#> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:Bundle;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "pcde-document"];
fhir:Resource.meta [
fhir:Meta.lastUpdated [ fhir:value "2019-07-21T11:01:00+05:00"^^xsd:dateTime ]
];
fhir:Bundle.identifier [
fhir:Identifier.system [ fhir:value "http://originalinsuranceinc.com/documentIDs" ];
fhir:Identifier.value [ fhir:value "A12345" ]
];
fhir:Bundle.type [ fhir:value "document"];
fhir:Bundle.timestamp [ fhir:value "2019-07-21T11:01:00+05:00"^^xsd:dateTime];
fhir:Bundle.entry [
fhir:index 0;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Composition/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Composition/1>
], [
fhir:index 1;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Patient/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Patient/1>
], [
fhir:index 2;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Coverage/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Coverage/1>
], [
fhir:index 3;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Organization/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Organization/1>
], [
fhir:index 4;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/CarePlan/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/CarePlan/1>
], [
fhir:index 5;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Claim/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Claim/1>
], [
fhir:index 6;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/ClaimResponse/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/ClaimResponse/1>
], [
fhir:index 7;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Practitioner/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Practitioner/1>
], [
fhir:index 8;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/ServiceRequest/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/ServiceRequest/1>
], [
fhir:index 9;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Condition/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Condition/1>
], [
fhir:index 10;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/PractitionerRole/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/PractitionerRole/1>
], [
fhir:index 11;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Practitioner/2" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Practitioner/2>
], [
fhir:index 12;
fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/DocumentReference/1" ];
fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/DocumentReference/1>
].
<http://originalinsuranceinc.com/fhir/Composition/1> a fhir:Composition;
fhir:Resource.id [ fhir:value "1"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "http://hl7.org/fhir/us/davinci-pcde/StructureDefinition/profile-composition";
fhir:index 0;
fhir:link <http://hl7.org/fhir/us/davinci-pcde/StructureDefinition/profile-composition> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>status</b>: final</p><p><b>type</b>: <span title=\"Codes: {http://hl7.org/fhir/us/davinci-pcde/CodeSystem/PCDEtempCodes pcde}\">Coverage Transition Document</span></p><p><b>date</b>: Jul 21, 2019 4:09:00 PM</p><p><b>author</b>: <a href=\"#Practitioner_1\">See above (Practitioner/1)</a></p><p><b>title</b>: Coverage Decision Exchange Document (Joe Smith, 2019-07-21)</p><h3>Events</h3><table class=\"grid\"><tr><td>-</td><td><b>Detail</b></td></tr><tr><td>*</td><td><a href=\"#Coverage_1\">See above (Coverage/1)</a></td></tr></table></div>"
];
fhir:Composition.status [ fhir:value "final"];
fhir:Composition.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pcde/CodeSystem/PCDEtempCodes" ];
fhir:Coding.code [ fhir:value "pcde" ] ]
];
fhir:Composition.subject [
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:Composition.date [ fhir:value "2019-07-21T23:09:00+07:00"^^xsd:dateTime];
fhir:Composition.author [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Practitioner/1" ]
];
fhir:Composition.title [ fhir:value "Coverage Decision Exchange Document (Joe Smith, 2019-07-21)"];
fhir:Composition.event [
fhir:index 0;
fhir:Composition.event.detail [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Coverage/1" ] ]
];
fhir:Composition.section [
fhir:index 0;
fhir:Composition.section.title [ fhir:value "Active Treatments" ];
fhir:Composition.section.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pcde/CodeSystem/PCDEtempCodes" ];
fhir:Coding.code [ fhir:value "activeTreatment" ] ] ];
fhir:Composition.section.section [
fhir:index 0;
fhir:Composition.section.title [ fhir:value "Consulation re: MCI" ];
fhir:Composition.section.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pcde/CodeSystem/PCDEtempCodes" ];
fhir:Coding.code [ fhir:value "treatment" ] ] ];
fhir:Composition.section.entry [
fhir:index 0;
fhir:Reference.reference [ fhir:value "CarePlan/1" ] ] ], [
fhir:index 1;
fhir:Composition.section.title [ fhir:value "Prior coverage" ];
fhir:Composition.section.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pcde/CodeSystem/PCDEtempCodes" ];
fhir:Coding.code [ fhir:value "priorCoverage" ] ] ];
fhir:Composition.section.entry [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Claim/1" ] ], [
fhir:index 1;
fhir:Reference.reference [ fhir:value "ClaimResponse/1" ] ] ], [
fhir:index 2;
fhir:Composition.section.title [ fhir:value "Supporting information" ];
fhir:Composition.section.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pcde/CodeSystem/PCDEtempCodes" ];
fhir:Coding.code [ fhir:value "supportingInfo" ] ] ];
fhir:Composition.section.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n Joe Smith is a subscriber to Maryland Capital Insurance Company. During a regular physical, Dr. James Gardener, Joe’s primary care physician, diagnosed a potential heart problem, acute myocardial infarction; unspecified site. \n Dr. Gardener had referred Joe to Dr. Susan Watson, a cardiologist for a consultation.\n During the consultation examination, Dr. Watson determined that Joe’s diagnosis requires hospitalization and a surgical procedure, a triple bypass venous graft. \n The operation and recovery was at Montgomery Hospital.\n </div>" ];
fhir:Composition.section.entry [
fhir:index 0;
fhir:Reference.reference [ fhir:value "DocumentReference/1" ] ] ]
].
<http://originalinsuranceinc.com/fhir/Patient/1> a fhir:Patient;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: id: 444222222</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>"
];
fhir:Patient.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://originalinsuranceinc.com/fhir/NamingSystem/client-ids" ];
fhir:Identifier.value [ fhir:value "444222222" ]
];
fhir:Patient.name [
fhir:index 0;
fhir:HumanName.family [ fhir:value "SMITH" ];
fhir:HumanName.given [
fhir:value "JOE";
fhir:index 0 ]
];
fhir:Patient.gender [ fhir:value "male"].
<http://originalinsuranceinc.com/fhir/Coverage/1> a fhir:Coverage;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>status</b>: active</p><p><b>subscriberId</b>: 12345678</p><p><b>beneficiary</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>payor</b>: <a href=\"#Organization_1\">See above (Organization/1)</a></p></div>"
];
fhir:Coverage.status [ fhir:value "active"];
fhir:Coverage.subscriberId [ fhir:value "12345678"];
fhir:Coverage.beneficiary [
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:Coverage.payor [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Organization/1" ]
].
<http://originalinsuranceinc.com/fhir/Organization/1> a fhir:Organization;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: id: 789312</p><p><b>active</b>: true</p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>"
];
fhir:Organization.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://originalinsuranceinc.com/fhir/NamingSystem/ETIN" ];
fhir:Identifier.value [ fhir:value "789312" ]
];
fhir:Organization.active [ fhir:value "true"^^xsd:boolean];
fhir:Organization.name [ fhir:value "MARYLAND CAPITAL INSURANCE COMPANY"].
<http://originalinsuranceinc.com/fhir/CarePlan/1> a fhir:CarePlan;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>instantiatesUri</b>: <a href=\"http://originalinsuranceinc.com/consultReviewURI\">http://originalinsuranceinc.com/consultReviewURI</a></p><p><b>status</b>: active</p><p><b>intent</b>: plan</p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/core/CodeSystem/careplan-category assess-plan}\">Assessment and Plan of Treatment</span></p><p><b>subject</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><blockquote><p><b>activity</b></p><h3>Details</h3><table class=\"grid\"><tr><td>-</td><td><b>Code</b></td><td><b>ReasonReference</b></td><td><b>Status</b></td></tr><tr><td>*</td><td><span title=\"Codes: {http://example.org/SERVICE_TYPE_CODE 3}\">Consultation</span></td><td><a href=\"#Condition_1\">See above (Condition/1)</a></td><td>in-progress</td></tr></table></blockquote></div>"
];
fhir:CarePlan.instantiatesUri [
fhir:value "http://originalinsuranceinc.com/consultReviewURI";
fhir:index 0
];
fhir:CarePlan.status [ fhir:value "active"];
fhir:CarePlan.intent [ fhir:value "plan"];
fhir:CarePlan.category [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/core/CodeSystem/careplan-category" ];
fhir:Coding.code [ fhir:value "assess-plan" ] ]
];
fhir:CarePlan.subject [
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:CarePlan.activity [
fhir:index 0;
fhir:CarePlan.activity.detail [
fhir:CarePlan.activity.detail.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/SERVICE_TYPE_CODE" ];
fhir:Coding.code [ fhir:value "3" ];
fhir:Coding.display [ fhir:value "Consultation" ] ] ];
fhir:CarePlan.activity.detail.reasonReference [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Condition/1" ] ];
fhir:CarePlan.activity.detail.status [ fhir:value "in-progress" ] ]
].
<http://originalinsuranceinc.com/fhir/Claim/1> a fhir:Claim;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>created</b>: 2019-07-20</p><p><b>insurer</b>: <a href=\"#Organization_1\">See above (Organization/1)</a></p><p><b>provider</b>: <a href=\"http://example.org/fhir/Organization/provider\">http://example.org/fhir/Organization/provider</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>-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td>*</td><td>1</td><td><a href=\"http://example.org/fhir/Organization/provider\">http://example.org/fhir/Organization/provider</a></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td>*</td><td>1</td><td><span title=\"Codes: {http://hl7.org/fhir/sid/icd-10-cm G89.4}\">Chronic pain syndrome</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><a href=\"#Coverage_1\">See above (Coverage/1)</a></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td>-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>DiagnosisSequence</b></td><td><b>ProductOrService</b></td><td><b>Location[x]</b></td></tr><tr><td>*</td><td>, , </td><td>1</td><td>1</td><td>1</td><td><span title=\"Codes: {http://codesystem.x12.org/005010/1365 3}\">Consultation</span></td><td><span title=\"Codes: {https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">11</span></td></tr></table></div>"
];
fhir:Claim.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://example.org/PATIENT_EVENT_TRACE_NUMBER" ];
fhir:Identifier.value [ fhir:value "111099" ];
fhir:Identifier.assigner [
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://example.org/USER_ASSIGNED" ];
fhir:Identifier.value [ fhir:value "9012345678" ] ] ]
];
fhir:Claim.status [ fhir:value "active"];
fhir:Claim.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
fhir:Coding.code [ fhir:value "professional" ] ]
];
fhir:Claim.use [ fhir:value "preauthorization"];
fhir:Claim.patient [
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:Claim.created [ fhir:value "2019-07-20"^^xsd:date];
fhir:Claim.insurer [
fhir:Reference.reference [ fhir:value "Organization/1" ]
];
fhir:Claim.provider [
fhir:link <http://example.org/fhir/Organization/provider>;
fhir:Reference.reference [ fhir:value "http://example.org/fhir/Organization/provider" ]
];
fhir:Claim.priority [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ];
fhir:Coding.code [ fhir:value "normal" ];
fhir:Coding.display [ fhir:value "Normal" ] ]
];
fhir:Claim.careTeam [
fhir:index 0;
fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.careTeam.provider [
fhir:link <http://example.org/fhir/Organization/provider>;
fhir:Reference.reference [ fhir:value "http://example.org/fhir/Organization/provider" ] ]
];
fhir:Claim.diagnosis [
fhir:index 0;
fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.diagnosis.diagnosisCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ];
fhir:Coding.code [ fhir:value "G89.4" ] ] ]
];
fhir:Claim.insurance [
fhir:index 0;
fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
fhir:Claim.insurance.coverage [
fhir:Reference.reference [ fhir:value "Coverage/1" ] ]
];
fhir:Claim.item [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1525" ];
fhir:Coding.code [ fhir:value "SC" ];
fhir:Coding.display [ fhir:value "Specialty Care Review" ] ] ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1322" ];
fhir:Coding.code [ fhir:value "I" ];
fhir:Coding.display [ fhir:value "Initial" ] ] ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService" ];
fhir:Extension.valueReference [
fhir:Reference.reference [ fhir:value "ServiceRequest/1" ] ] ];
fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.item.careTeamSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0 ];
fhir:Claim.item.diagnosisSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0 ];
fhir:Claim.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1365" ];
fhir:Coding.code [ fhir:value "3" ];
fhir:Coding.display [ fhir:value "Consultation" ] ] ];
fhir:Claim.item.locationCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set" ];
fhir:Coding.code [ fhir:value "11" ] ] ]
].
<http://originalinsuranceinc.com/fhir/ClaimResponse/1> a fhir:ClaimResponse;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "extensions" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>created</b>: 2019-07-20</p><p><b>insurer</b>: <a href=\"#Organization_1\">See above (Organization/1)</a></p><p><b>requestor</b>: <a href=\"http://example.org/fhir/Organization/provider\">http://example.org/fhir/Organization/provider</a></p><p><b>outcome</b>: complete</p><blockquote><p><b>item</b></p><blockquote><p><b>ReviewAction</b></p><h3>Urls</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table><p><b>value</b>: AUTH0001</p><h3>Urls</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table><p><b>value</b>: <span title=\"Codes: {http://codesystem.x12.org/005010/306 A1}\">Certified in total</span></p></blockquote><p><b>AuthorizedDate</b>: 2005-05-02 --> 2005-06-02</p><p><b>itemSequence</b>: 1</p><h3>Adjudications</h3><table class=\"grid\"><tr><td>-</td><td><b>Category</b></td></tr><tr><td>*</td><td><span title=\"Codes: {http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td></tr></table></blockquote></div>"
];
fhir:ClaimResponse.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://example.org/PATIENT_EVENT_TRACE_NUMBER" ];
fhir:Identifier.value [ fhir:value "111099" ];
fhir:Identifier.assigner [
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://example.org/USER_ASSIGNED" ];
fhir:Identifier.value [ fhir:value "9012345678" ] ] ]
];
fhir:ClaimResponse.status [ fhir:value "active"];
fhir:ClaimResponse.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
fhir:Coding.code [ fhir:value "professional" ] ]
];
fhir:ClaimResponse.use [ fhir:value "preauthorization"];
fhir:ClaimResponse.patient [
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:ClaimResponse.created [ fhir:value "2019-07-20"^^xsd:date];
fhir:ClaimResponse.insurer [
fhir:Reference.reference [ fhir:value "Organization/1" ]
];
fhir:ClaimResponse.requestor [
fhir:link <http://example.org/fhir/Organization/provider>;
fhir:Reference.reference [ fhir:value "http://example.org/fhir/Organization/provider" ]
];
fhir:ClaimResponse.outcome [ fhir:value "complete"];
fhir:ClaimResponse.item [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction" ];
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "number" ];
fhir:Extension.valueString [ fhir:value "AUTH0001" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/306" ];
fhir:Coding.code [ fhir:value "A1" ];
fhir:Coding.display [ fhir:value "Certified in total" ] ] ] ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDate" ];
fhir:Extension.valuePeriod [
fhir:Period.start [ fhir:value "2005-05-02"^^xsd:date ];
fhir:Period.end [ fhir:value "2005-06-02"^^xsd:date ] ] ];
fhir:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ClaimResponse.item.adjudication [
fhir:index 0;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ];
fhir:Coding.code [ fhir:value "submitted" ] ] ] ]
].
<http://originalinsuranceinc.com/fhir/Practitioner/1> a fhir:Practitioner;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: id: 8189991234</p><p><b>name</b>: JAMES GARDENER </p></div>"
];
fhir:Practitioner.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://originalinsuranceinc.com/fhir/NamingSystem/ETIN" ];
fhir:Identifier.value [ fhir:value "8189991234" ]
];
fhir:Practitioner.name [
fhir:index 0;
fhir:HumanName.family [ fhir:value "GARDENER" ];
fhir:HumanName.given [
fhir:value "JAMES";
fhir:index 0 ]
].
<http://originalinsuranceinc.com/fhir/ServiceRequest/1> a fhir:ServiceRequest;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>code</b>: <span title=\"Codes: {http://codesystem.x12.org/005010/1365 3}\">Consultation</span></p><p><b>quantity</b>: 1 VS</p><p><b>subject</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>performer</b>: <a href=\"#PractitionerRole_1\">See above (PractitionerRole/1)</a></p></div>"
];
fhir:ServiceRequest.status [ fhir:value "active"];
fhir:ServiceRequest.intent [ fhir:value "order"];
fhir:ServiceRequest.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1365" ];
fhir:Coding.code [ fhir:value "3" ];
fhir:Coding.display [ fhir:value "Consultation" ] ]
];
fhir:ServiceRequest.quantityQuantity [
fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ];
fhir:Quantity.unit [ fhir:value "VS" ]
];
fhir:ServiceRequest.subject [
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:ServiceRequest.performer [
fhir:index 0;
fhir:Reference.reference [ fhir:value "PractitionerRole/1" ]
].
<http://originalinsuranceinc.com/fhir/Condition/1> a fhir:Condition;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>category</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/condition-category encounter-diagnosis}\">Encounter Diagnosis</span></p><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/sid/icd-9-cm 410.90}\">Acute myocardial infarction of unspecified site, episode of care unspecified</span></p><p><b>subject</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>recordedDate</b>: 2005-04-30</p></div>"
];
fhir:Condition.category [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-category" ];
fhir:Coding.code [ fhir:value "encounter-diagnosis" ] ]
];
fhir:Condition.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-9-cm" ];
fhir:Coding.code [ fhir:value "410.90" ] ]
];
fhir:Condition.subject [
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:Condition.recordedDate [ fhir:value "2005-04-30"^^xsd:date].
<http://originalinsuranceinc.com/fhir/PractitionerRole/1> a fhir:PractitionerRole;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>practitioner</b>: <a href=\"#Practitioner_2\">See above (Practitioner/2)</a></p><p><b>code</b>: <span title=\"Codes: {http://example.org/fhir/NamingSystem/ENTITY_IDENTIFIER_CODE 1P}\">Provider</span></p></div>"
];
fhir:PractitionerRole.practitioner [
fhir:Reference.reference [ fhir:value "Practitioner/2" ]
];
fhir:PractitionerRole.code [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/NamingSystem/ENTITY_IDENTIFIER_CODE" ];
fhir:Coding.code [ fhir:value "1P" ];
fhir:Coding.display [ fhir:value "Provider" ] ]
].
<http://originalinsuranceinc.com/fhir/Practitioner/2> a fhir:Practitioner;
fhir:Resource.id [ fhir:value "2"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: id: 987654321</p><p><b>name</b>: SUSAN WATSON </p><p><b>telecom</b>: ph: 4029993456</p></div>"
];
fhir:Practitioner.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://originalinsuranceinc.com/fhir/NamingSystem/practitioner-id" ];
fhir:Identifier.value [ fhir:value "987654321" ]
];
fhir:Practitioner.name [
fhir:index 0;
fhir:HumanName.family [ fhir:value "WATSON" ];
fhir:HumanName.given [
fhir:value "SUSAN";
fhir:index 0 ]
];
fhir:Practitioner.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "4029993456" ]
].
<http://originalinsuranceinc.com/fhir/DocumentReference/1> a fhir:DocumentReference;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>status</b>: current</p><p><b>docStatus</b>: final</p><p><b>type</b>: <span title=\"Codes: {http://loinc.org 18842-5}\">Discharge summary</span></p><p><b>subject</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>author</b>: <a href=\"#Practitioner_1\">See above (Practitioner/1)</a></p><blockquote><p><b>content</b></p><h3>Attachments</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote></div>"
];
fhir:DocumentReference.status [ fhir:value "current"];
fhir:DocumentReference.docStatus [ fhir:value "final"];
fhir:DocumentReference.type [
fhir:CodeableConcept.coding [
fhir:index 0;
a loinc:18842-5;
fhir:Coding.system [ fhir:value "http://loinc.org" ];
fhir:Coding.code [ fhir:value "18842-5" ] ]
];
fhir:DocumentReference.subject [
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:DocumentReference.author [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Practitioner/1" ]
];
fhir:DocumentReference.content [
fhir:index 0;
fhir:DocumentReference.content.attachment [
fhir:Attachment.url [ fhir:value "http://originalinsuranceinc.com/fhir/Binary/DischargeSummaryDocument" ] ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2019+ HL7 International - Financial Management Work Group. Package hl7.fhir.us.davinci-pcde#1.0.0 based on FHIR 4.0.1. Generated 2020-12-23
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