ELTSS 0.1.0 - STU1 Ballot 1

This page is part of the electronic Long-Term Services and Supports Implementation Guide (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

eLTSS Contract Example - XML Representation

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Raw xml 


<Bundle xmlns="http://hl7.org/fhir">
  <id value="contract-contract1"/>
  <type value="collection"/>
<!--   Support Planner (CarePlan author)  -->
  <entry>
    <fullUrl value="http://example.org/eLTSS/planner"/>
    <resource>
      <Practitioner>
        <id value="planner1"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/eltss/StructureDefinition/practitioner-eltss"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">
            <p><b>Support Planner / Phone:</b> Mark Planner / (678) 555 1221</p>
          </div>
        </text>
      <!--  identifier is required by US Core  -->
        <identifier>
          <system value="http://www.acme.org/practitioners"/>
          <value value="23"/>
        </identifier>
      <!--  [eLTSS Support Planner Name]  -->
        <name>
          <text value="Mark Planner"/>
          <family value="Planner"/>
          <given value="Mark"/>
        </name>
      <!--  [eLTSS Support Planner Phone Number]  -->
        <telecom>
          <system value="phone"/>
          <value value="(678) 555 1221"/>
        </telecom>
      </Practitioner>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/eLTSS/caremgr"/>
    <resource>
      <Practitioner>
        <id value="caremgr1"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/eltss/StructureDefinition/practitioner-eltss"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">
            <p><b>Plan Monitor / Phone:</b> Sam Monitor / (770) 224 1599</p>
          </div>
        </text>
      <!--  identifier is required by US Core  -->
        <identifier>
          <system value="http://www.acme.org/practitioners"/>
          <value value="24"/>
        </identifier>
      <!--  [eLTSS Plan Monitor Name]  -->
        <name>
          <text value="Sam Monitor"/>
          <family value="Monitor"/>
          <given value="Sam"/>
        </name>
      <!--  [eLTSS Plan Monitor Phone Number]  -->
        <telecom>
          <system value="phone"/>
          <value value="(770) 224 1599"/>
        </telecom>
      </Practitioner>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/eLTSS/provider1"/>
    <resource>
      <Practitioner>
        <id value="provider1"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/eltss/StructureDefinition/practitioner-eltss"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">
            <p><b>Provider:</b> Lisa Performer </p>
          </div>
        </text>
      <!--  identifier is required by US Core  -->
        <identifier>
          <system value="http://www.acme.org/practitioners"/>
          <value value="987654"/>
        </identifier>
      <!--  [eLTSS Service Provider Name]  -->
        <name>
          <text value="Lisa Performer"/>
          <family value="Performer"/>
          <given value="Lisa"/>
        </name>
      <!--  [eLTSS Service Provider Phone Number]  -->
        <telecom>
          <system value="phone"/>
          <value value="(404) 555 1213"/>
        </telecom>
      </Practitioner>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/eLTSS/provider2"/>
    <resource>
      <Organization>
        <id value="provider2"/>
      <!--  identifier is required by US Core  -->
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">
            <p><b>Organization:</b> The Transporter</p>
          </div>
        </text>
        <identifier>
          <value value="24680"/>
        </identifier>
      <!--  [eLTSS Service Provider Name]  -->
        <name value="The Transporter, Inc."/>
      <!--  [eLTSS Service Provider Phone Number]  -->
        <telecom>
          <system value="phone"/>
          <value value="(404) 555 1313"/>
        </telecom>
      <!--  address is required by US Core  -->
        <address>
          <text value="111 Business Street, Atlanta GA, 30318"/>
        </address>
      </Organization>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/eLTSS/provider3"/>
    <resource>
      <Practitioner>
        <id value="provider3"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/eltss/StructureDefinition/practitioner-eltss"/>
        </meta>
      <!--  identifier is required by US Core  -->
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">
            <p><b>Practitioner:</b> Bill Driver</p>
          </div>
        </text>
        <identifier>
          <system value="http://www.acme.org/practitioners"/>
          <value value="11223344"/>
        </identifier>
      <!--  [eLTSS Service Provider Name]  -->
        <name>
          <text value="Bill Driver"/>
          <family value="Driver"/>
          <given value="Bill"/>
        </name>
      <!--  [eLTSS Service Provider Phone Number]  -->
        <telecom>
          <system value="phone"/>
          <value value="(678) 111 2222"/>
        </telecom>
      </Practitioner>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/eLTSS/contract"/>
    <resource>
      <Contract>
        <id value="contract1"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/eltss/StructureDefinition/contract-eltss"/>
        </meta>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">
            <p>eLTSS Signature in Contract form [eLTSS Support Planner Signature], [eLTSS Support Planner Printed Name], [eLTSS Support Planner Signature Date]  </p>
          </div>
        </text>
        <signer>
          <type>
            <system
                    value="http://terminology.hl7.org/CodeSystem/contractsignertypecodes"/>
            <code value="AUT"/>
          </type>
          <party>
            <reference value="Practitioner/planner1"/>
          </party>
          <signature>
            <type>
            <!--               <system value="urn:iso-astm:E1762-95:2013"/>  -->
              <code value="1.2.840.10065.1.12.1.1"/>
            </type>
            <when value="2018-04-02T03:00:00Z"/>
            <who>
              <reference value="Practitioner/planner1"/>
            </who>
            <sigFormat value="image/jpeg"/>
            <data
                  value="R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="/>
          </signature>
        </signer>
      <!--  Service Provider #1  -->
      <!--  [eLTSS Service Provider Signature], [eLTSS Service Provider Printed Name], [eLTSS Service Provider Signature Date]   -->
        <signer>
          <type>
            <system
                    value="http://terminology.hl7.org/CodeSystem/contractsignertypecodes"/>
            <code value="HPROV"/>
          </type>
          <party>
            <reference value="Practitioner/provider1"/>
          </party>
          <signature>
            <type>
            <!--               <system value="urn:iso-astm:E1762-95:2013"/>  -->
              <code value="1.2.840.10065.1.12.1.7"/>
            </type>
            <when value="2018-04-02T03:00:00Z"/>
            <who>
              <reference value="Practitioner/provider1"/>
            </who>
            <sigFormat value="image/jpeg"/>
            <data
                  value="R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="/>
          </signature>
        </signer>
      <!--  Service Provider #2  -->
      <!--  [eLTSS Service Provider Signature], [eLTSS Service Provider Printed Name], [eLTSS Service Provider Signature Date]   -->
        <signer>
          <type>
            <system
                    value="http://terminology.hl7.org/CodeSystem/contractsignertypecodes"/>
            <code value="HPROV"/>
          </type>
          <party>
            <reference value="Organization/provider2"/>
          </party>
          <signature>
            <type>
            <!--               <system value="urn:iso-astm:E1762-95:2013"/>  -->
              <code value="1.2.840.10065.1.12.1.7"/>
            </type>
            <when value="2018-04-02T03:00:00Z"/>
          <!--  In this example, the service provider is the transportation company, and the signer is a representative of that company  -->
            <who>
              <reference value="Practitioner/provider3"/>
            </who>
            <sigFormat value="image/jpeg"/>
            <data
                  value="R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="/>
          </signature>
        </signer>
      </Contract>
    </resource>
  </entry>
</Bundle>