Electronic Long-Term Services and Supports (eLTSS) Release 1 - US Realm

This page is part of the electronic Long-Term Services and Supports Implementation Guide (v1.0.0: STU 1) based on FHIR R4. This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

eLTSS Contract Example - JSON Representation

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Raw json

{
  "resourceType" : "Bundle",
  "id" : "contract-contract1",
  "type" : "collection",
  "entry" : [
    {
      "fullUrl" : "http://example.org/eLTSS/planner",
      "resource" : {
        "resourceType" : "Practitioner",
        "id" : "planner1",
        "meta" : {
          "profile" : [
            "http://hl7.org/fhir/us/eltss/StructureDefinition/Practitioner-eltss"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            <p><b>Support Planner / Phone:</b> Mark Planner / (678) 555 1221</p>\n          </div>"
        },
        "identifier" : [
          {
            "system" : "http://www.acme.org/practitioners",
            "value" : "23"
          }
        ],
        "name" : [
          {
            "text" : "Mark Planner",
            "family" : "Planner",
            "given" : [
              "Mark"
            ]
          }
        ],
        "telecom" : [
          {
            "system" : "phone",
            "value" : "(678) 555 1221"
          }
        ]
      }
    },
    {
      "fullUrl" : "http://example.org/eLTSS/caremgr",
      "resource" : {
        "resourceType" : "Practitioner",
        "id" : "caremgr1",
        "meta" : {
          "profile" : [
            "http://hl7.org/fhir/us/eltss/StructureDefinition/Practitioner-eltss"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            <p><b>Plan Monitor / Phone:</b> Sam Monitor / (770) 224 1599</p>\n          </div>"
        },
        "identifier" : [
          {
            "system" : "http://www.acme.org/practitioners",
            "value" : "24"
          }
        ],
        "name" : [
          {
            "text" : "Sam Monitor",
            "family" : "Monitor",
            "given" : [
              "Sam"
            ]
          }
        ],
        "telecom" : [
          {
            "system" : "phone",
            "value" : "(770) 224 1599"
          }
        ]
      }
    },
    {
      "fullUrl" : "http://example.org/eLTSS/provider1",
      "resource" : {
        "resourceType" : "Practitioner",
        "id" : "provider1",
        "meta" : {
          "profile" : [
            "http://hl7.org/fhir/us/eltss/StructureDefinition/Practitioner-eltss"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            <p><b>Provider:</b> Lisa Performer </p>\n          </div>"
        },
        "identifier" : [
          {
            "system" : "http://www.acme.org/practitioners",
            "value" : "987654"
          }
        ],
        "name" : [
          {
            "text" : "Lisa Performer",
            "family" : "Performer",
            "given" : [
              "Lisa"
            ]
          }
        ],
        "telecom" : [
          {
            "system" : "phone",
            "value" : "(404) 555 1213"
          }
        ]
      }
    },
    {
      "fullUrl" : "http://example.org/eLTSS/provider2",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "provider2",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            <p><b>Organization:</b> The Transporter</p>\n          </div>"
        },
        "identifier" : [
          {
            "value" : "24680"
          }
        ],
        "name" : "The Transporter, Inc.",
        "telecom" : [
          {
            "system" : "phone",
            "value" : "(404) 555 1313"
          }
        ],
        "address" : [
          {
            "text" : "111 Business Street, Atlanta GA, 30318"
          }
        ]
      }
    },
    {
      "fullUrl" : "http://example.org/eLTSS/provider3",
      "resource" : {
        "resourceType" : "Practitioner",
        "id" : "provider3",
        "meta" : {
          "profile" : [
            "http://hl7.org/fhir/us/eltss/StructureDefinition/Practitioner-eltss"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            <p><b>Practitioner:</b> Bill Driver</p>\n          </div>"
        },
        "identifier" : [
          {
            "system" : "http://www.acme.org/practitioners",
            "value" : "11223344"
          }
        ],
        "name" : [
          {
            "text" : "Bill Driver",
            "family" : "Driver",
            "given" : [
              "Bill"
            ]
          }
        ],
        "telecom" : [
          {
            "system" : "phone",
            "value" : "(678) 111 2222"
          }
        ]
      }
    },
    {
      "fullUrl" : "http://example.org/eLTSS/contract",
      "resource" : {
        "resourceType" : "Contract",
        "id" : "contract1",
        "meta" : {
          "profile" : [
            "http://hl7.org/fhir/us/eltss/StructureDefinition/Contract-eltss"
          ]
        },
        "text" : {
          "status" : "additional",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            <p>eLTSS Signature in Contract form [eLTSS Support Planner Signature], [eLTSS Support Planner Printed Name], [eLTSS Support Planner Signature Date]  </p>\n          </div>"
        },
        "signer" : [
          {
            "type" : {
              "system" : "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
              "code" : "AUT"
            },
            "party" : {
              "reference" : "Practitioner/planner1"
            },
            "signature" : [
              {
                "type" : [
                  {
                    "code" : "1.2.840.10065.1.12.1.1"
                  }
                ],
                "when" : "2018-04-02T03:00:00Z",
                "who" : {
                  "reference" : "Practitioner/planner1"
                },
                "sigFormat" : "image/jpeg",
                "data" : "R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="
              }
            ]
          },
          {
            "type" : {
              "system" : "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
              "code" : "HPROV"
            },
            "party" : {
              "reference" : "Practitioner/provider1"
            },
            "signature" : [
              {
                "type" : [
                  {
                    "code" : "1.2.840.10065.1.12.1.7"
                  }
                ],
                "when" : "2018-04-02T03:00:00Z",
                "who" : {
                  "reference" : "Practitioner/provider1"
                },
                "sigFormat" : "image/jpeg",
                "data" : "R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="
              }
            ]
          },
          {
            "type" : {
              "system" : "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
              "code" : "HPROV"
            },
            "party" : {
              "reference" : "Organization/provider2"
            },
            "signature" : [
              {
                "type" : [
                  {
                    "code" : "1.2.840.10065.1.12.1.7"
                  }
                ],
                "when" : "2018-04-02T03:00:00Z",
                "who" : {
                  "reference" : "Practitioner/provider3"
                },
                "sigFormat" : "image/jpeg",
                "data" : "R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="
              }
            ]
          }
        ]
      }
    }
  ]
}