Da Vinci Payer Data Exchange
2.0.0 - STU2
Da Vinci Payer Data Exchange
2.0.0 - STU2
This page is part of the Da Vinci Payer Data Exchange (v2.0.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="1000000-1"/>
<meta>
<profile value="http://hl7.org/fhir/StructureDefinition/Bundle"/>
</meta>
<type value="transaction-response"/>
<timestamp value="2019-12-31T20:26:23.217+00:00"/>
<link>
<relation value="self"/>
<url
value="https://example.com/base/fhir/Patient?ct=W2idG9rZW4iOiIrUklEOn53MThjQUk5RlVPZ0lEQUFBQUFBQU"/>
</link>
<entry>
<fullUrl value="https://example.com/base/Patient/1"/>
<resource>
<Patient>
<id value="1"/>
<meta>
<lastUpdated value="2019-07-07T13:26:22.0314215+00:00"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"/>
</meta>
<language value="en-US"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US"><p><b>Generated Narrative: Patient</b><a name="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 Patient "1" Updated "2019-07-07 13:26:22+0000" (Language "en-US") </p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-patient.html">US Core Patient Profile</a></p></div><p><b>identifier</b>: Member Number: https://www.xxxhealthplan.com/fhir/memberidentifier#1234-234-1243-12345678901, Medical record number: 1234-234-1243-12345678901m, Health Plan Identifier: 1234-234-1243-12345678901u, Patient external identifier: 1234-234-1243-12345678901a</p><p><b>active</b>: true</p><p><b>name</b>: Johnny Appleseed </p><p><b>telecom</b>: ph: (443)555-1212, ph: (410)678-2323</p><p><b>gender</b>: male</p><p><b>birthDate</b>: 1986-01-01</p><p><b>address</b>: 123 Main Street Pittsburgh PA 12519 </p><p><b>maritalStatus</b>: unknown <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-v3-NullFlavor.html">NullFlavor</a>#UNK)</span></p></div>
</text>
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MB"/>
</coding>
</type>
<system
value="https://www.xxxhealthplan.com/fhir/memberidentifier"/>
<value
value="https://www.xxxhealthplan.com/fhir/memberidentifier#1234-234-1243-12345678901"/>
</identifier>
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MR"/>
</coding>
</type>
<system
value="https://www.xxxhealthplan.com/fhir/medicalrecordnumber"/>
<value value="1234-234-1243-12345678901m"/>
</identifier>
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="XV"/>
</coding>
</type>
<system
value="https://www.xxxhealthplan.com/fhir/uniquememberidentifier"/>
<value value="1234-234-1243-12345678901u"/>
</identifier>
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="PT"/>
</coding>
</type>
<system value="https://www.xxxhealthplan.com/fhir/patacctnum"/>
<value value="1234-234-1243-12345678901a"/>
</identifier>
<active value="true"/>
<name>
<family value="Appleseed"/>
<given value="Johnny"/>
</name>
<telecom>
<system value="phone"/>
<value value="(443)555-1212"/>
<rank value="1"/>
</telecom>
<telecom>
<system value="phone"/>
<value value="(410)678-2323"/>
<rank value="2"/>
</telecom>
<gender value="male"/>
<birthDate value="1986-01-01"/>
<address>
<type value="physical"/>
<line value="123 Main Street"/>
<city value="Pittsburgh"/>
<state value="PA"/>
<postalCode value="12519"/>
</address>
<maritalStatus>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
<code value="UNK"/>
</coding>
</maritalStatus>
</Patient>
</resource>
<response>
<status value="200"/>
</response>
</entry>
<entry>
<fullUrl value="https://example.com/base/Encounter/6-1"/>
<resource>
<Encounter>
<id value="6-1"/>
<meta>
<lastUpdated value="2019-07-14T19:26:23.217+00:00"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Encounter</b><a name="6-1"> </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 Encounter "6-1" Updated "2019-07-14 19:26:23+0000" </p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-encounter.html">US Core Encounter Profile</a></p></div><p><b>status</b>: finished</p><p><b>class</b>: Ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'Ambulatory')</p><p><b>type</b>: Consultation <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT[US]</a>#11429006)</span></p><p><b>subject</b>: <a href="#Patient_1">See above (Patient/1)</a></p></div>
</text>
<status value="finished"/>
<class>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="AMB"/>
<display value="Ambulatory"/>
</class>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<version value="http://snomed.info/sct/731000124108"/>
<code value="11429006"/>
<display value="Consultation"/>
</coding>
</type>
<subject>🔗
<reference value="Patient/1"/>
</subject>
</Encounter>
</resource>
<response>
<status value="200"/>
</response>
</entry>
<entry>
<fullUrl value="https://example.com/base/Encounter/7-1"/>
<resource>
<Encounter>
<id value="7-1"/>
<meta>
<lastUpdated value="2019-10-15T20:26:23.217+00:00"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Encounter</b><a name="7-1"> </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 Encounter "7-1" Updated "2019-10-15 20:26:23+0000" </p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-encounter.html">US Core Encounter Profile</a></p></div><p><b>status</b>: finished</p><p><b>class</b>: Ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'Ambulatory')</p><p><b>type</b>: Consultation <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT[US]</a>#11429006)</span></p><p><b>subject</b>: <a href="#Patient_1">See above (Patient/1)</a></p></div>
</text>
<status value="finished"/>
<class>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="AMB"/>
<display value="Ambulatory"/>
</class>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<version value="http://snomed.info/sct/731000124108"/>
<code value="11429006"/>
<display value="Consultation"/>
</coding>
</type>
<subject>🔗
<reference value="Patient/1"/>
</subject>
</Encounter>
</resource>
<response>
<status value="200"/>
</response>
</entry>
<entry>
<fullUrl value="https://example.com/base/Provenance/1000002-1"/>
<resource>
<Provenance>
<id value="1000002-1"/>
<meta>
<versionId value="1"/>
<lastUpdated value="2019-07-14T19:26:23.217+00:00"/>
<profile
value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Provenance</b><a name="1000002-1"> </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 Provenance "1000002-1" Version "1" Updated "2019-07-14 19:26:23+0000" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-pdex-provenance.html">PDex Provenance</a></p></div><p><b>target</b>: <a href="#Encounter_6-1">See above (https://example.com/base/Encounter/6-1)</a></p><p><b>recorded</b>: Jul 10, 2020, 4:26:23 PM</p><h3>Agents</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Who</b></td></tr><tr><td style="display: none">*</td><td>Author <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-provenance-participant-type.html">Provenance participant type</a>#author)</span></td><td><a href="Organization-ProviderOrg1.html">Organization/ProviderOrg1</a> "Provider 1"</td></tr></table><h3>Entities</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Extension</b></td><td><b>Role</b></td><td><b>What</b></td></tr><tr><td style="display: none">*</td><td/><td>source</td><td><span>: No reference available</span></td></tr></table></div>
</text>
<target>
<reference value="https://example.com/base/Encounter/6-1"/>
</target>
<recorded value="2020-07-10T16:26:23.217+00:00"/>
<agent>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/>
<code value="author"/>
<display value="Author"/>
</coding>
</type>
<who>🔗
<reference value="Organization/ProviderOrg1"/>
</who>
</agent>
<entity>
<extension
url="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/ProvenanceSourceFrom">
<valueCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/ProvenancePayerDataSource"/>
<code value="hl7ccda"/>
<display value="HL7 C-CDA"/>
</coding>
</valueCodeableConcept>
</extension>
<role value="source"/>
<what>
<display value="No reference available"/>
</what>
</entity>
</Provenance>
</resource>
<response>
<status value="200"/>
</response>
</entry>
<entry>
<fullUrl value="https://example.com/base/Provenance/1000003-1"/>
<resource>
<Provenance>
<id value="1000003-1"/>
<meta>
<versionId value="1"/>
<lastUpdated value="2019-10-15T20:26:23.217+00:00"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Provenance</b><a name="1000003-1"> </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 Provenance "1000003-1" Version "1" Updated "2019-10-15 20:26:23+0000" </p></div><p><b>target</b>: <a href="#Encounter_7-1">See above (Encounter/7-1)</a></p><p><b>recorded</b>: Jul 10, 2020, 4:26:23 PM</p><h3>Agents</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Who</b></td></tr><tr><td style="display: none">*</td><td>Author <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-provenance-participant-type.html">Provenance participant type</a>#author)</span></td><td><a href="Organization-ProviderOrg1.html">Organization/ProviderOrg1</a> "Provider 1"</td></tr></table><h3>Entities</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Extension</b></td><td><b>Role</b></td><td><b>What</b></td></tr><tr><td style="display: none">*</td><td/><td>source</td><td><span>: No reference available</span></td></tr></table></div>
</text>
<target>
<reference value="Encounter/7-1"/>
</target>
<recorded value="2020-07-10T16:26:23.217+00:00"/>
<agent>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/>
<code value="author"/>
<display value="Author"/>
</coding>
</type>
<who>🔗
<reference value="Organization/ProviderOrg1"/>
</who>
</agent>
<entity>
<extension
url="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/ProvenanceSourceFrom">
<valueCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/ProvenancePayerDataSource"/>
<code value="hl7ccda"/>
<display value="HL7 C-CDA"/>
</coding>
</valueCodeableConcept>
</extension>
<role value="source"/>
<what>
<display value="No reference available"/>
</what>
</entity>
</Provenance>
</resource>
<response>
<status value="200"/>
</response>
</entry>
<entry>
<fullUrl value="https://example.com/base/Provenance/1000004-1"/>
<resource>
<Provenance>
<id value="1000004-1"/>
<meta>
<versionId value="1"/>
<lastUpdated value="2019-12-31T20:26:23.217+00:00"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Provenance</b><a name="1000004-1"> </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 Provenance "1000004-1" Version "1" Updated "2019-12-31 20:26:23+0000" </p></div><p><b>target</b>: <a href="Bundle-1000000-1.html">Bundle/1000000-1</a></p><p><b>recorded</b>: Dec 31, 2019, 8:26:23 PM</p><h3>Agents</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Role</b></td><td><b>Who</b></td></tr><tr><td style="display: none">*</td><td>Transmitter <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-us-core-provenance-participant-type.html">US Core Provenance Participant Type Extension Codes</a>#transmitter)</span></td><td>Transcriber <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-contractsignertypecodes.html">Contract Signer Type Codes</a>#TRANS)</span></td><td><a href="Organization-Payer1.html">Organization/Payer1</a> "Payer 1"</td></tr></table></div>
</text>
<target>🔗
<reference value="Bundle/1000000-1"/>
</target>
<recorded value="2019-12-31T20:26:23.217+00:00"/>
<agent>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type"/>
<code value="transmitter"/>
<display value="Transmitter"/>
</coding>
</type>
<role>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/contractsignertypecodes"/>
<code value="TRANS"/>
</coding>
</role>
<who>🔗
<reference value="Organization/Payer1"/>
</who>
</agent>
</Provenance>
</resource>
<response>
<status value="200"/>
</response>
</entry>
</Bundle>
IG © 2020+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pdex#2.0.0 based on FHIR 4.0.1. Generated 2024-01-06
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