HL7.FHIR.US.DAVINCI-PDEX\ExampleMedicationDispenseClaim - FHIR v4.0.1

Da Vinci Payer Data Exchange
1.0.0 - STU1

This page is part of the Da Vinci Payer Data Exchange (v1.0.0: STU1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

Example MedicationDispense: ExampleMedicationDispenseClaim

Generated Narrative

An attribute to express the refill number of a prescription: 1

status: completed

medication: 30 TABLET in 1 BLISTER PACK (54458-872-10)

subject: Generated Summary: language: en-US; 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; active; Johnny Appleseed ; Phone: (410)678-2323; gender: male; birthDate: 1986-01-01; unknown

Performers

-

Actor

*

Generated Summary: National Provider Identifier: 874635264; Susan Smith ; Phone: 3015551234; gender: female; birthDate: 1965-11-15

location: Generated Summary: name: MyFavorite Pharmacy

type: Refill

quantity: 60

daysSupply: 30