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 R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: ExampleMedicationDispenseClaim - XML Representation

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<MedicationDispense xmlns="http://hl7.org/fhir">
  <id value="1000001"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2020-07-09T15:26:23.217+00:00"/>
    <profile
             value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-medicationdispense"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><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>: <span title="Codes: {http://hl7.org/fhir/sid/ndc 54458-872-10}">30 TABLET in 1 BLISTER PACK (54458-872-10)</span></p><p><b>subject</b>: <a href="Patient-1.html">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; <span title="Codes: {http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}">unknown</span></a></p><h3>Performers</h3><table class="grid"><tr><td>-</td><td><b>Actor</b></td></tr><tr><td>*</td><td><a href="Practitioner-4.html">Generated Summary: National Provider Identifier: 874635264; Susan Smith ; Phone: 3015551234; gender: female; birthDate: 1965-11-15</a></td></tr></table><p><b>location</b>: <a href="Location-5.html">Generated Summary: name: MyFavorite Pharmacy</a></p><p><b>type</b>: <span title="Codes: {http://terminology.hl7.org/CodeSystem/v3-ActCode RF}">Refill</span></p><p><b>quantity</b>: 60</p><p><b>daysSupply</b>: 30</p></div>
  </text>
  <extension
             url="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/DispenseRefill">
    <valueQuantity>
      <value value="1"/>
    </valueQuantity>
  </extension>
  <status value="completed"/>
  <medicationCodeableConcept>
    <coding>
      <system value="http://hl7.org/fhir/sid/ndc"/>
      <code value="54458-872-10"/>
    </coding>
  </medicationCodeableConcept>
  <subject>
    <reference value="Patient/1"/>
  </subject>
  <performer>
    <actor>
      <reference value="Practitioner/4"/>
    </actor>
  </performer>
  <location>
    <reference value="Location/5"/>
  </location>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="RF"/>
    </coding>
  </type>
  <quantity>
    <value value="60"/>
  </quantity>
  <daysSupply>
    <value value="30"/>
  </daysSupply>
</MedicationDispense>