Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot US

This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

: PCT-GFE-Missing-Bundle-1 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@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:id [ fhir:v "PCT-GFE-Missing-Bundle-1"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-missing-bundle"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-missing-bundle>     ] )
  ] ; # 
  fhir:type [ fhir:v "collection"] ; # 
  fhir:timestamp [ fhir:v "2024-03-27T11:01:00+05:00"^^xsd:dateTime] ; # 
  fhir:entry ( [
fhir:id [ fhir:v "org1002" ] ;
fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/org1002"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/Organization/org1002> )
  ] [
fhir:id [ fhir:v "patient1001" ] ;
fhir:fullUrl [ fhir:v "http://example.org/fhir/Patient/patient1001"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/Patient/patient1001> )
  ] [
fhir:id [ fhir:v "coverage1001" ] ;
fhir:fullUrl [ fhir:v "http://example.org/fhir/Coverage/coverage1001"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/Coverage/coverage1001> )
  ] [
fhir:id [ fhir:v "PCT-DeviceRequest-1" ] ;
fhir:fullUrl [ fhir:v "http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1> )
  ] ) . # 

<http://example.org/fhir/Organization/org1002> a fhir:Organization ;
  fhir:id [ fhir:v "org1002"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "additional" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"org1002\"></a><a name=\"hcorg1002\"></a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Organization &quot;org1002&quot;</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-organization.html\">PCT Organization</a></p></div><p><b>identifier</b>: National provider identifier/1234568095, Tax ID number/TAX-3211001</p><p><b>active</b>: true</p><p><b>type</b>: Healthcare Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-organization-type.html\">Organization type</a>#prov)</span></p><p><b>name</b>: Boston Radiology Center</p><p><b>telecom</b>: ph: 781-232-3200(WORK)</p><p><b>address</b>: 32 Fruit Street Boston MA 02114 US</p></div>"
  ] ; # 
  fhir:identifier ( [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ;
fhir:code [ fhir:v "NPI" ]       ] )     ] ;
fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ;
fhir:value [ fhir:v "1234568095" ]
  ] [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TAX" ]       ] )     ] ;
fhir:system [ fhir:v "urn:oid:2.16.840.1.113883.4.4"^^xsd:anyURI ] ;
fhir:value [ fhir:v "TAX-3211001" ]
  ] ) ; # 
  fhir:active [ fhir:v "true"^^xsd:boolean] ; # 
  fhir:type ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "prov" ] ;
fhir:display [ fhir:v "Healthcare Provider" ]     ] )
  ] ) ; # 
  fhir:name [ fhir:v "Boston Radiology Center"] ; # 
  fhir:telecom ( [
fhir:system [ fhir:v "phone" ] ;
fhir:value [ fhir:v "781-232-3200" ] ;
fhir:use [ fhir:v "work" ]
  ] ) ; # 
  fhir:address ( [
    ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/countrySubdivisionCode"^^xsd:anyURI ] ;
fhir:value [
a fhir:Coding ;
fhir:system [ fhir:v "urn:iso:std:iso:3166:-2"^^xsd:anyURI ] ;
fhir:code [ fhir:v "US-MA" ]       ]     ] ) ;
    ( fhir:line [ fhir:v "32 Fruit Street" ] ) ;
fhir:city [ fhir:v "Boston" ] ;
fhir:state [ fhir:v "MA" ] ;
fhir:postalCode [ fhir:v "02114" ] ;
fhir:country [ fhir:v "US" ]
  ] ) . # 

<http://example.org/fhir/Patient/patient1001> a fhir:Patient ;
  fhir:id [ fhir:v "patient1001"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "additional" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\"><b>Eve Betterhalf</b> female, DoB: 1955-07-23 ( <code>http://example.com/identifiers/patient</code>/1001)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Known Marital status of Patient\">Marital Status:</td><td colspan=\"3\"><span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-MaritalStatus U}\">unmarried</span></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Details:</td><td colspan=\"3\"><ul><li>ph: 781-949-4949(MOBILE)</li><li>222 Burlington Road, Bedford MA 01730</li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Languages spoken\">Language:</td><td colspan=\"3\"><span title=\"Codes: {urn:ietf:bcp:47 en-US}\">English (United States)</span> (preferred)</td></tr></table></div>"
  ] ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "http://example.com/identifiers/patient"^^xsd:anyURI ] ;
fhir:value [ fhir:v "1001" ]
  ] ) ; # 
  fhir:name ( [
fhir:text [ fhir:v "Eve Betterhalf" ] ;
fhir:family [ fhir:v "Betterhalf" ] ;
    ( fhir:given [ fhir:v "Eve" ] )
  ] ) ; # 
  fhir:telecom ( [
fhir:system [ fhir:v "phone" ] ;
fhir:value [ fhir:v "781-949-4949" ] ;
fhir:use [ fhir:v "mobile" ]
  ] ) ; # 
  fhir:gender [ fhir:v "female"] ; # 
  fhir:birthDate [ fhir:v "1955-07-23"^^xsd:date] ; # 
  fhir:address ( [
fhir:text [ fhir:v "222 Burlington Road, Bedford MA 01730" ]
  ] ) ; # 
  fhir:maritalStatus [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus"^^xsd:anyURI ] ;
fhir:code [ fhir:v "U" ] ;
fhir:display [ fhir:v "unmarried" ]     ] )
  ] ; # 
  fhir:communication ( [
fhir:language [
      ( fhir:coding [
fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ] ;
fhir:code [ fhir:v "en-US" ] ;
fhir:display [ fhir:v "English (United States)" ]       ] )     ] ;
fhir:preferred [ fhir:v "true"^^xsd:boolean ]
  ] ) . # 

<http://example.org/fhir/Coverage/coverage1001> a fhir:Coverage ;
  fhir:id [ fhir:v "coverage1001"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "additional" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"coverage1001\"></a><a name=\"hccoverage1001\"></a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Coverage &quot;coverage1001&quot;</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-coverage.html\">PCT Coverage</a></p></div><p><b>Extension Definition for Coverage.kind for Version 5.0</b>: insurance</p><p><b>status</b>: active</p><p><b>subscriberId</b>: PFP123450000</p><p><b>beneficiary</b>: <a href=\"Patient-patient1001.html\">Patient/patient1001</a> &quot; BETTERHALF&quot;</p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2021-01-01 --&gt; 2022-01-01</p><p><b>payor</b>: <a href=\"Organization-org1001.html\">Organization/org1001</a> &quot;Umbrella Insurance Company&quot;</p><h3>Classes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td style=\"display: none\">*</td><td>Plan <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#plan)</span></td><td>Premim Family Plus</td><td>Premim Family Plus Plan</td></tr></table><h3>CostToBeneficiaries</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>Copay Percentage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-copay-type.html\">Coverage Copay Type Codes</a>#copaypct)</span></td><td>20</td></tr></table></div>"
  ] ; # 
  fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind"^^xsd:anyURI ] ;
fhir:value [ fhir:v "insurance" ]
  ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/selfPayDeclared"^^xsd:anyURI ] ;
fhir:value [ fhir:v "false"^^xsd:boolean ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:subscriberId [ fhir:v "PFP123450000"] ; # 
  fhir:beneficiary [
fhir:reference [ fhir:v "Patient/patient1001" ]
  ] ; # 
  fhir:relationship [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ;
fhir:code [ fhir:v "self" ] ;
fhir:display [ fhir:v "Self" ]     ] )
  ] ; # 
  fhir:period [
fhir:start [ fhir:v "2021-01-01"^^xsd:date ] ;
fhir:end [ fhir:v "2022-01-01"^^xsd:date ]
  ] ; # 
  fhir:payor ( [
fhir:reference [ fhir:v "Organization/org1001" ]
  ] ) ; # 
  fhir:class ( [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
fhir:code [ fhir:v "plan" ] ;
fhir:display [ fhir:v "Plan" ]       ] )     ] ;
fhir:value [ fhir:v "Premim Family Plus" ] ;
fhir:name [ fhir:v "Premim Family Plus Plan" ]
  ] ) ; # 
  fhir:costToBeneficiary ( [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-copay-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "copaypct" ] ;
fhir:display [ fhir:v "Copay Percentage" ]       ] )     ] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "20"^^xsd:decimal ]     ]
  ] ) . # 

<http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1> a fhir:DeviceRequest ;
  fhir:id [ fhir:v "PCT-DeviceRequest-1"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-devicerequest"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-devicerequest>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "additional" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"PCT-DeviceRequest-1\"></a><a name=\"hcPCT-DeviceRequest-1\"></a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource DeviceRequest &quot;PCT-DeviceRequest-1&quot;</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-devicerequest.html\">PCT GFE DeviceRequest</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: proposal</p><p><b>code</b>: KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(HCPCSReleaseCodeSets#L1820)</span></p><p><b>subject</b>: <a href=\"Patient-patient1001.html\">Patient/patient1001</a> &quot; BETTERHALF&quot;</p></div>"
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:intent [ fhir:v "proposal"] ; # 
  fhir:code [
a fhir:CodeableConcept ;
    ( fhir:coding [
fhir:system [ fhir:v "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"^^xsd:anyURI ] ;
fhir:code [ fhir:v "L1820" ] ;
fhir:display [ fhir:v "KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT" ]     ] )
  ] ; # 
  fhir:subject [
fhir:reference [ fhir:v "Patient/patient1001" ]
  ] . #