Da Vinci Payer Data Exchange
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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

: ExampleMedicationDispenseClaim - JSON Representation

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{
  "resourceType" : "MedicationDispense",
  "id" : "1000001",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2020-07-09T15:26:23.217+00:00",
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-medicationdispense"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: MedicationDispense</b><a name=\"1000001\"> </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 MedicationDispense &quot;1000001&quot; Version &quot;1&quot; Updated &quot;2020-07-09 15:26:23+0000&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-pdex-medicationdispense.html\">PDex MedicationDispense</a></p></div><p><b>An attribute to express the refill number of a prescription</b>: 1</p><p><b>status</b>: completed</p><p><b>medication</b>: Lisinopril, 30 TABLET in 1 BLISTER PACK (54458-872-10) (package) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-v3-ndc.html\">National drug codes</a>#54458-872-10)</span></p><p><b>subject</b>: <a href=\"Patient-1.html\">Patient/1</a> &quot; APPLESEED&quot;</p><h3>Performers</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Actor</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Practitioner-4.html\">Practitioner/4</a> &quot; SMITH&quot;</td></tr></table><p><b>location</b>: <a href=\"Location-5.html\">Location/5</a> &quot;MyFavorite Pharmacy&quot;</p><p><b>type</b>: Refill <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v3-ActCode.html\">ActCode</a>#RF)</span></p><p><b>quantity</b>: 60</p><p><b>daysSupply</b>: 30</p></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/DispenseRefill",
      "valueQuantity" : {
        "value" : 1
      }
    }
  ],
  "status" : "completed",
  "medicationCodeableConcept" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/sid/ndc",
        "code" : "54458-872-10"
      }
    ]
  },
  "subject" : {
    🔗 "reference" : "Patient/1"
  },
  "performer" : [
    {
      "actor" : {
        🔗 "reference" : "Practitioner/4"
      }
    }
  ],
  "location" : {
    🔗 "reference" : "Location/5"
  },
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "RF"
      }
    ]
  },
  "quantity" : {
    "value" : 60
  },
  "daysSupply" : {
    "value" : 30
  }
}