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. For a full list of available versions, see the Directory of published versions 
{
"resourceType" : "Bundle",
"id" : "careplan",
"type" : "collection",
"entry" : [
{
"fullUrl" : "http://example.org/eLTSS/careplan1",
"resource" : {
"resourceType" : "CarePlan",
"id" : "careplan1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/CarePlan-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p>\n <b>Sally Person's Long Term Services and Supports (LTSS) Service Plan</b>\n </p>\n <p><b>Plan Effective Date:</b> 2018-05-01 - 2018-12-31</p>\n <p><b>Step or Action:</b> client action - manage diet</p>\n <p><b>Step or Action:</b> client action - exercise / join a fitness club</p>\n </div>"
},
"status" : "active",
"intent" : "plan",
"category" : [
{
"coding" : [
{
"system" : "http://hl7.org/fhir/us/core/CodeSystem/careplan-category",
"code" : "assess-plan"
}
]
}
],
"subject" : {
"reference" : "Patient/patient1"
},
"period" : {
"start" : "2018-05-01",
"end" : "2018-12-31"
},
"author" : {
"reference" : "Practitioner/planner1"
},
"addresses" : [
{
"reference" : "Condition/need1"
},
{
"reference" : "Condition/need2"
},
{
"reference" : "Condition/need3"
}
],
"supportingInfo" : [
{
"reference" : "Observation/strength1"
},
{
"reference" : "QuestionnaireResponse/questionnaireresponse1"
},
{
"reference" : "Contract/contract1"
},
{
"reference" : "RiskAssessment/risk1"
}
],
"goal" : [
{
"reference" : "Goal/goal1"
},
{
"reference" : "Goal/goal2"
}
],
"activity" : [
{
"detail" : {
"goal" : [
{
"reference" : "Goal/goal1"
}
],
"status" : "not-started",
"description" : "manage diet"
}
},
{
"detail" : {
"goal" : [
{
"reference" : "Goal/goal2"
}
],
"status" : "not-started",
"description" : "exercise / join a fitness club"
}
},
{
"reference" : {
"reference" : "ServiceRequest/service1"
}
},
{
"reference" : {
"reference" : "ServiceRequest/service2"
}
},
{
"reference" : {
"reference" : "ServiceRequest/service3"
}
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/planner1",
"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://fhir.hl7.org/sid/us-npi",
"value" : "9941339108"
},
{
"system" : "http://www.acme.org/practitioners",
"value" : "25456"
}
],
"name" : [
{
"text" : "Mark Planner",
"family" : "Planner",
"given" : [
"Mark"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "(212) 555 1221"
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/caremgr1",
"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://hl7.org.fhir/sid/us-npi",
"value" : "9941339109"
},
{
"system" : "http://www.acme.org/practitioners",
"value" : "25457"
}
],
"name" : [
{
"text" : "Sam Monitor",
"family" : "Monitor",
"given" : [
"Sam"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "(770) 224 1599"
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/patient1",
"resource" : {
"resourceType" : "Patient",
"id" : "patient1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Patient-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Person Name:</b> Sally Person</p>\n <p><b>Person Identifier | Type:</b> 123456ABC | MRN</p>\n <p><b>Person Phone:</b> (404) 555 1212</p>\n <p><b>Person Date of Birth:</b> 1935-05-01</p>\n <p><b>Person Address:</b> 2222 Peachtree Street, Atlanta GA, 30318</p>\n <p><b>Emergency Contact Name:</b> Jane Daughter</p>\n <p><b>Emergency Contact Relationship:</b> daughter</p>\n <p><b>Emergency Contact Phone Number:</b> (770) 224 1544</p>\n </div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MR"
}
]
},
"system" : "http://www.example.org/Codesystem",
"value" : "123456ABC"
}
],
"name" : [
{
"text" : "Sally Person",
"family" : "Person",
"given" : [
"Sally"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "(404) 555 1212"
}
],
"gender" : "female",
"birthDate" : "1935-05-01",
"address" : [
{
"text" : "2222 Peachtree Street, Atlanta GA, 30318",
"line" : [
"2222 Peachtree Street"
],
"city" : "Atlanta",
"district" : "Fulton",
"state" : "GA",
"postalCode" : "30318"
}
],
"contact" : [
{
"relationship" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/fhir/v2/0131",
"code" : "C"
}
]
},
{
"coding" : [
{
"system" : "http://terminology.hl7.org/fhir/v3/RoleCode",
"code" : "DAUC"
}
]
}
],
"name" : {
"text" : "Jane Daughter",
"family" : "Daughter",
"given" : [
"Jane"
]
},
"telecom" : [
{
"system" : "phone",
"value" : "(770) 224 1544"
}
]
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/episode1",
"resource" : {
"resourceType" : "EpisodeOfCare",
"id" : "episode1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/EpisodeOfCare-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: episode1</p><p><b>meta</b>: </p><p><b>status</b>: active</p><p><b>patient</b>: <a href=\"Patient/patient1\">Patient/patient1</a></p><p><b>careManager</b>: <a href=\"Practitioner/caremgr1\">Practitioner/caremgr1</a></p></div>"
},
"status" : "active",
"patient" : {
"reference" : "Patient/patient1"
},
"careManager" : {
"reference" : "Practitioner/caremgr1"
}
}
},
{
"fullUrl" : "http://example.org/eLTSS/careplan2",
"resource" : {
"resourceType" : "CarePlan",
"id" : "careplan2",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/CarePlan-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: careplan2</p><p><b>meta</b>: </p><p><b>partOf</b>: <a href=\"CarePlan/careplan1\">CarePlan/careplan1</a></p><p><b>status</b>: active</p><p><b>intent</b>: plan</p><p><b>category</b>: Assessment and Plan of Treatment <span style=\"background: LightGoldenRodYellow\">(Details : {http://hl7.org/fhir/us/core/CodeSystem/careplan-category code 'assess-plan' = 'Assessment and Plan of Treatment)</span></p><p><b>description</b>: Snow Emergencies: A shelf stable blizzard meal is delivered to Meals On Wheels clients in early winter. It is to be eaten in the unlikely event of cancellation. Blizzard meals are donated by the Sheboygan Service Club.</p><p><b>subject</b>: <a href=\"Patient/patient1\">Patient/patient1</a></p></div>"
},
"partOf" : [
{
"reference" : "CarePlan/careplan1"
}
],
"status" : "active",
"intent" : "plan",
"category" : [
{
"coding" : [
{
"system" : "http://hl7.org/fhir/us/core/CodeSystem/careplan-category",
"code" : "assess-plan"
}
]
}
],
"description" : "Snow Emergencies: A shelf stable blizzard meal is delivered to Meals On Wheels clients in early winter. It is to be eaten in the unlikely event of cancellation. Blizzard meals are donated by the Sheboygan Service Club.",
"subject" : {
"reference" : "Patient/patient1"
}
}
},
{
"fullUrl" : "http://example.org/eLTSS/goal1",
"resource" : {
"resourceType" : "Goal",
"id" : "goal1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Goal-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Person Goal:</b> lose weight</p>\n </div>"
},
"lifecycleStatus" : "accepted",
"description" : {
"text" : "lose weight"
},
"subject" : {
"reference" : "Patient/patient1"
}
}
},
{
"fullUrl" : "http://example.org/eLTSS/goal2",
"resource" : {
"resourceType" : "Goal",
"id" : "goal2",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Goal-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Person Goal:</b> dance at daughter's wedding</p>\n </div>"
},
"lifecycleStatus" : "accepted",
"description" : {
"text" : "dance at daughter's wedding"
},
"subject" : {
"reference" : "Patient/patient1"
}
}
},
{
"fullUrl" : "http://example.org/eLTSS/need1",
"resource" : {
"resourceType" : "Condition",
"id" : "need1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Condition-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Assessed Need:</b> lack of transportation</p>\n </div>"
},
"clinicalStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code" : "active"
}
]
},
"verificationStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code" : "confirmed"
}
]
},
"category" : [
{
"coding" : [
{
"system" : "http://hl7.org/fhir/us/eltss/CodeSystem/eltss-condition-category-code",
"code" : "assessed-need"
}
]
}
],
"code" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "713458007",
"display" : "Lack of access to transportation (finding)"
}
],
"text" : "lack of transportation"
},
"subject" : {
"reference" : "Patient/patient1"
}
}
},
{
"fullUrl" : "http://example.org/eLTSS/need2",
"resource" : {
"resourceType" : "Condition",
"id" : "need2",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Condition-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Assessed Need:</b> difficulty in bathing</p>\n </div>"
},
"clinicalStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code" : "active"
}
]
},
"verificationStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code" : "confirmed"
}
]
},
"category" : [
{
"coding" : [
{
"system" : "http://hl7.org/fhir/us/eltss/CodeSystem/eltss-condition-category-code",
"code" : "assessed-need"
}
]
}
],
"code" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "284807005",
"display" : "Difficulty bathing self (finding)"
}
],
"text" : "difficulty in bathing"
},
"subject" : {
"reference" : "Patient/patient1"
}
}
},
{
"fullUrl" : "http://example.org/eLTSS/need3",
"resource" : {
"resourceType" : "Condition",
"id" : "need3",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Condition-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Assessed Need:</b> difficulty in dressing</p>\n </div>"
},
"clinicalStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code" : "active"
}
]
},
"verificationStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code" : "confirmed"
}
]
},
"category" : [
{
"coding" : [
{
"system" : "http://hl7.org/fhir/us/eltss/CodeSystem/eltss-condition-category-code",
"code" : "assessed-need"
}
]
}
],
"code" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "284972002",
"display" : "Difficulty performing dressing activity (finding)"
}
],
"text" : "difficulty in dressing"
},
"subject" : {
"reference" : "Patient/patient1"
}
}
},
{
"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\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: provider1</p><p><b>meta</b>: </p><p><b>identifier</b>: 987654</p><p><b>name</b>: Lisa Performer</p><p><b>telecom</b>: ph: (404) 555 1213</p></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\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: provider2</p><p><b>identifier</b>: 24680</p><p><b>name</b>: The Transporter, Inc.</p><p><b>telecom</b>: ph: (404) 555 1313</p><p><b>address</b>: 111 Business Street, Atlanta GA, 30318</p></div>"
},
"identifier" : [
{
"system" : "http://www.acme.org/practitioners",
"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\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: provider3</p><p><b>meta</b>: </p><p><b>identifier</b>: 11223344</p><p><b>name</b>: Bill Driver</p><p><b>telecom</b>: ph: (678) 111 2222</p></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/funding1",
"resource" : {
"resourceType" : "Organization",
"id" : "funding1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Service Funding Source:</b> Georgia Department of Community Health</p>\n </div>"
},
"identifier" : [
{
"value" : "ICWP"
}
],
"name" : "Georgia Department of Community Health",
"address" : [
{
"text" : "2 Main Street, Atlanta GA, 30318"
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/relative1",
"resource" : {
"resourceType" : "RelatedPerson",
"id" : "daughter1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: daughter1</p><p><b>patient</b>: <a href=\"Patient/patient1\">Patient/patient1</a></p><p><b>relationship</b>: daughter <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/v3-RoleCode code 'DAUC' = 'daughter)</span></p><p><b>name</b>: Jane Daughter</p></div>"
},
"patient" : {
"reference" : "Patient/patient1"
},
"relationship" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code" : "DAUC"
}
]
}
],
"name" : [
{
"text" : "Jane Daughter",
"family" : "Daughter",
"given" : [
"Jane"
]
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/guardian1",
"resource" : {
"resourceType" : "RelatedPerson",
"id" : "guardian1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: guardian1</p><p><b>patient</b>: <a href=\"Patient/patient1\">Patient/patient1</a></p><p><b>name</b>: William Barrister</p></div>"
},
"patient" : {
"reference" : "Patient/patient1"
},
"name" : [
{
"text" : "William Barrister",
"family" : "Barrister",
"given" : [
"William"
]
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/service1",
"resource" : {
"resourceType" : "ServiceRequest",
"id" : "service1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/ServiceRequest-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Service Name:</b> Personal care services, per 15 minutes - 5 units per week</p>\n <p><b>Service Start Date / End Date:</b> 2018-05-01 / 2018-12-31</p>\n </div>"
},
"status" : "active",
"intent" : "plan",
"code" : {
"coding" : [
{
"system" : "urn:oid:2.16.840.1.113883.6.14",
"code" : "T1019"
}
],
"text" : "Personal care services, per 15 minutes"
},
"quantityRatio" : {
"numerator" : {
"value" : 5,
"unit" : "quarter hour"
},
"denominator" : {
"value" : 1,
"unit" : "week"
}
},
"subject" : {
"reference" : "Patient/patient1"
},
"occurrencePeriod" : {
"start" : "2018-05-01",
"end" : "2018-12-31"
},
"performer" : [
{
"reference" : "Practitioner/provider1"
}
],
"locationReference" : [
{
"reference" : "Location/location1"
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/service2",
"resource" : {
"resourceType" : "ServiceRequest",
"id" : "service2",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/ServiceRequest-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Service Name:</b> Non-emergency transportation; encounter/trip - 10 trips total</p>\n <p><b>Service Start Date / End Date:</b> 2018-07-01 / 2018-12-31</p>\n </div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/us/eltss/StructureDefinition/eltss-directedBy",
"valueCodeableConcept" : {
"text" : "self"
}
}
],
"status" : "active",
"intent" : "plan",
"code" : {
"coding" : [
{
"system" : "urn:oid:2.16.840.1.113883.6.14",
"code" : "T2003"
}
],
"text" : "Non-emergency transportation; encounter/trip"
},
"quantityQuantity" : {
"value" : 10,
"unit" : "trips"
},
"subject" : {
"reference" : "Patient/patient1"
},
"occurrencePeriod" : {
"start" : "2018-07-01",
"end" : "2018-12-31"
},
"performer" : [
{
"reference" : "Organization/provider2"
}
],
"insurance" : [
{
"reference" : "Coverage/coverage1"
}
],
"supportingInfo" : [
{
"reference" : "Claim/claim1"
}
],
"note" : [
{
"text" : "Service provider will provide a reminder the business day before the trip, and will call when on the way."
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/service3",
"resource" : {
"resourceType" : "ServiceRequest",
"id" : "service3",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/ServiceRequest-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Service Name:</b> House cleaning - one per week</p>\n <p><b>Service Start Date / End Date:</b> 2018-05-01 / 2018-12-31</p>\n </div>"
},
"status" : "active",
"intent" : "plan",
"code" : {
"text" : "House cleaning"
},
"quantityRatio" : {
"numerator" : {
"value" : 1,
"unit" : "visit"
},
"denominator" : {
"value" : 1,
"unit" : "week"
}
},
"subject" : {
"reference" : "Patient/patient1"
},
"occurrencePeriod" : {
"start" : "2018-05-01",
"end" : "2018-12-31"
},
"performer" : [
{
"reference" : "RelatedPerson/daughter1"
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/strength1",
"resource" : {
"resourceType" : "Observation",
"id" : "strength1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Observation-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Person Strength:</b> Able to manage her bills. Has strong family support.</p>\n </div>"
},
"status" : "final",
"code" : {
"coding" : [
{
"system" : "http://hl7.org/us/eLTSS/CodeSystem/eltss-observation-code",
"code" : "strength"
}
]
},
"valueString" : "Able to manage her bills. Has strong family support."
}
},
{
"fullUrl" : "http://example.org/eLTSS/pref1",
"resource" : {
"resourceType" : "Observation",
"id" : "pref1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Observation-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p><b>Person Preference:</b> Accessing the ICWP Waiver for her current service needs, and would like to remain on ICWP and continue with her current services.</p>\n </div>"
},
"status" : "final",
"code" : {
"coding" : [
{
"system" : "http://hl7.org/us/eLTSS/CodeSystem/eltss-observation-code",
"code" : "preference"
}
]
},
"valueString" : "Accessing the ICWP Waiver for her current service needs, and would like to remain on ICWP and continue with her current services."
}
},
{
"fullUrl" : "http://example.org/eLTSS/risk1",
"resource" : {
"resourceType" : "RiskAssessment",
"id" : "risk1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/RiskAssessment-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: risk1</p><p><b>meta</b>: </p><p><b>status</b>: final</p><p><b>subject</b>: <a href=\"Patient/patient1\">Patient/patient1</a></p><h3>Predictions</h3><table class=\"grid\"><tr><td>-</td><td><b>Outcome</b></td></tr><tr><td>*</td><td>At risk of falls <span style=\"background: LightGoldenRodYellow\">(Details : {SNOMED CT code '129839007' = 'At risk of falls)</span></td></tr></table><p><b>mitigation</b>: risk management plan text goes here</p></div>"
},
"status" : "final",
"subject" : {
"reference" : "Patient/patient1"
},
"prediction" : [
{
"outcome" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "129839007"
}
]
}
}
],
"mitigation" : "risk management plan text goes here"
}
},
{
"fullUrl" : "http://example.org/eLTSS/questionnaire1",
"resource" : {
"resourceType" : "Questionnaire",
"id" : "questionnaire1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Questionnaire-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: questionnaire1</p><p><b>meta</b>: </p><p><b>name</b>: Questionnaire1</p><p><b>status</b>: active</p><blockquote><p><b>item</b></p><p><b>linkId</b>: q1</p><p><b>text</b>: Did you choose the setting in which you reside?</p><p><b>type</b>: boolean</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q2</p><p><b>text</b>: What alternative home and community-based settings were considered?</p><p><b>type</b>: string</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q3</p><p><b>text</b>: Were you given a choice of services outlined in the plan?</p><p><b>type</b>: boolean</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q4</p><p><b>text</b>: Did you participate in the selection of services outlined in the plan?</p><p><b>type</b>: boolean</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q5</p><p><b>text</b>: Do you agree to the services outlined in the plan?</p><p><b>type</b>: boolean</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q6</p><p><b>text</b>: Were you offerred a choice of providers for each service?</p><p><b>type</b>: boolean</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q7</p><p><b>text</b>: Do you feel you made an informed choice in selecting the provider for each service?</p><p><b>type</b>: boolean</p></blockquote></div>"
},
"name" : "Questionnaire1",
"status" : "active",
"item" : [
{
"linkId" : "q1",
"text" : "Did you choose the setting in which you reside?",
"type" : "boolean"
},
{
"linkId" : "q2",
"text" : "What alternative home and community-based settings were considered?",
"type" : "string"
},
{
"linkId" : "q3",
"text" : "Were you given a choice of services outlined in the plan?",
"type" : "boolean"
},
{
"linkId" : "q4",
"text" : "Did you participate in the selection of services outlined in the plan?",
"type" : "boolean"
},
{
"linkId" : "q5",
"text" : "Do you agree to the services outlined in the plan?",
"type" : "boolean"
},
{
"linkId" : "q6",
"text" : "Were you offerred a choice of providers for each service?",
"type" : "boolean"
},
{
"linkId" : "q7",
"text" : "Do you feel you made an informed choice in selecting the provider for each service?",
"type" : "boolean"
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/qr1",
"resource" : {
"resourceType" : "QuestionnaireResponse",
"id" : "questionnaireresponse1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: questionnaireresponse1</p><p><b>questionnaire</b>: <a href=\"http://example.org/eLTSS/questionnaire1\">http://example.org/eLTSS/questionnaire1</a></p><p><b>status</b>: completed</p><blockquote><p><b>item</b></p><p><b>linkId</b>: q1</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>true</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q2</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Assisted living facility</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q3</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>true</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q4</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>true</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q5</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>true</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q6</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>true</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: q7</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>true</td></tr></table></blockquote></div>"
},
"questionnaire" : "http://example.org/eLTSS/questionnaire1",
"status" : "completed",
"item" : [
{
"linkId" : "q1",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "q2",
"answer" : [
{
"valueString" : "Assisted living facility"
}
]
},
{
"linkId" : "q3",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "q4",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "q5",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "q6",
"answer" : [
{
"valueBoolean" : true
}
]
},
{
"linkId" : "q7",
"answer" : [
{
"valueBoolean" : true
}
]
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/contract1",
"resource" : {
"resourceType" : "Contract",
"id" : "contract1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Contract-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: contract1</p><p><b>meta</b>: </p><blockquote><p><b>signer</b></p><p><b>type</b>: Patient (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code PAT = 'Patient', stated as 'null')</p><p><b>party</b>: <a href=\"Patient/patient1\">Patient/patient1</a></p><p><b>signature</b>: </p></blockquote><blockquote><p><b>signer</b></p><p><b>type</b>: Guardian (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code GUARD = 'Guardian', stated as 'null')</p><p><b>party</b>: <a href=\"RelatedPerson/guardian1\">RelatedPerson/guardian1</a></p><p><b>signature</b>: </p></blockquote><blockquote><p><b>signer</b></p><p><b>type</b>: Author (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code AUT = 'Author', stated as 'null')</p><p><b>party</b>: <a href=\"Practitioner/planner1\">Practitioner/planner1</a></p><p><b>signature</b>: </p></blockquote><blockquote><p><b>signer</b></p><p><b>type</b>: Healthcare Provider (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code HPROV = 'Healthcare Provider', stated as 'null')</p><p><b>party</b>: <a href=\"Practitioner/provider1\">Practitioner/provider1</a></p><p><b>signature</b>: </p></blockquote><blockquote><p><b>signer</b></p><p><b>type</b>: Healthcare Provider (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code HPROV = 'Healthcare Provider', stated as 'null')</p><p><b>party</b>: <a href=\"Practitioner/provider3\">Practitioner/provider3</a></p><p><b>signature</b>: </p></blockquote><blockquote><p><b>signer</b></p><p><b>type</b>: Healthcare Provider (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code HPROV = 'Healthcare Provider', stated as 'null')</p><p><b>party</b>: <a href=\"RelatedPerson/daughter1\">RelatedPerson/daughter1</a></p><p><b>signature</b>: </p></blockquote></div>"
},
"signer" : [
{
"type" : {
"system" : "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
"code" : "PAT"
},
"party" : {
"reference" : "Patient/patient1"
},
"signature" : [
{
"type" : [
{
"system" : "urn:iso-astm:E1762-95:2013",
"code" : "1.2.840.10065.1.12.1.7"
}
],
"when" : "2018-04-02T03:00:00Z",
"who" : {
"reference" : "Patient/patient1"
},
"data" : "R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="
}
]
},
{
"type" : {
"system" : "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
"code" : "GUARD"
},
"party" : {
"reference" : "RelatedPerson/guardian1"
},
"signature" : [
{
"type" : [
{
"system" : "urn:iso-astm:E1762-95:2013",
"code" : "1.2.840.10065.1.12.1.7"
}
],
"when" : "2018-04-02T03:00:00Z",
"who" : {
"reference" : "RelatedPerson/guardian1"
},
"data" : "R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="
}
]
},
{
"type" : {
"system" : "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
"code" : "AUT"
},
"party" : {
"reference" : "Practitioner/planner1"
},
"signature" : [
{
"type" : [
{
"system" : "urn:iso-astm:E1762-95:2013",
"code" : "1.2.840.10065.1.12.1.1"
}
],
"when" : "2018-04-02T03:00:00Z",
"who" : {
"reference" : "Practitioner/planner1"
},
"data" : "R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="
}
]
},
{
"type" : {
"system" : "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
"code" : "HPROV"
},
"party" : {
"reference" : "Practitioner/provider1"
},
"signature" : [
{
"type" : [
{
"system" : "urn:iso-astm:E1762-95:2013",
"code" : "1.2.840.10065.1.12.1.7"
}
],
"when" : "2018-04-02T03:00:00Z",
"who" : {
"reference" : "Practitioner/provider1"
},
"data" : "R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="
}
]
},
{
"type" : {
"system" : "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
"code" : "HPROV"
},
"party" : {
"reference" : "Practitioner/provider3"
},
"signature" : [
{
"type" : [
{
"system" : "urn:iso-astm:E1762-95:2013",
"code" : "1.2.840.10065.1.12.1.7"
}
],
"when" : "2018-04-02T03:00:00Z",
"who" : {
"reference" : "Practitioner/provider3"
},
"data" : "R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="
}
]
},
{
"type" : {
"system" : "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
"code" : "HPROV"
},
"party" : {
"reference" : "RelatedPerson/daughter1"
},
"signature" : [
{
"type" : [
{
"system" : "urn:iso-astm:E1762-95:2013",
"code" : "1.2.840.10065.1.12.1.7"
}
],
"when" : "2018-04-02T03:00:00Z",
"who" : {
"reference" : "RelatedPerson/daughter1"
},
"data" : "R0lGODlhIAAgALMAADNmmWNjnGOcnJycnJzOnM7OnP///////////////////////////////////////yH5BAEAAAUALAAAAAAgACAAAARosMhJq704680l6OD0fSFHFmd5pai6vi7FerGYzWAK7HKs8zYVazcUVojH0gyZzFmYvQ4OGtXgUMDn5kqtwlZZLeaKJXOtYbG31lrXdKb0lyySi+l1PE1v5CtpbE0eRISFhod+gYoXEQAAOw=="
}
]
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/location1",
"resource" : {
"resourceType" : "Location",
"id" : "location1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Location-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: location1</p><p><b>meta</b>: </p><p><b>name</b>: In Home</p><p><b>address</b>: 2222 Peachtree Street, Atlanta GA, 30318</p></div>"
},
"name" : "In Home",
"address" : {
"text" : "2222 Peachtree Street, Atlanta GA, 30318"
}
}
},
{
"fullUrl" : "http://example.org/eLTSS/coverage1",
"resource" : {
"resourceType" : "Coverage",
"id" : "coverage1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: coverage1</p><p><b>status</b>: active</p><p><b>beneficiary</b>: <a href=\"Patient/patient1\">Patient/patient1</a></p><p><b>payor</b>: <a href=\"Organization/funding1\">Organization/funding1</a></p></div>"
},
"status" : "active",
"beneficiary" : {
"reference" : "Patient/patient1"
},
"payor" : [
{
"reference" : "Organization/funding1"
}
]
}
},
{
"fullUrl" : "http://example.org/eLTSS/claim2",
"resource" : {
"resourceType" : "Claim",
"id" : "claim1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/eltss/StructureDefinition/Claim-eltss"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: claim1</p><p><b>meta</b>: </p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/claim-type code 'professional' = 'Professional)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient/patient1\">Patient/patient1</a></p><p><b>created</b>: Jan 1, 2019 12:00:00 AM</p><p><b>provider</b>: <a href=\"Organization/funding1\">Organization/funding1</a></p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/processpriority code 'normal' = 'Normal)</span></p><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><a href=\"Coverage/coverage1\">Coverage/coverage1</a></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>ProductOrService</b></td><td><b>UnitPrice</b></td><td><b>Net</b></td></tr><tr><td>*</td><td>1</td><td>Exam, comp, primary <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/ex-USCLS code '1101' = 'Exam, comp, primary)</span></td><td/><td/></tr></table></div>"
},
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "professional"
}
]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/patient1"
},
"created" : "2019-01-01",
"provider" : {
"reference" : "Organization/funding1"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "Coverage/coverage1"
}
}
],
"item" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code" : "1101"
}
]
},
"unitPrice" : {
"value" : 60.00
},
"net" : {
"value" : 600.00
}
}
]
}
}
]
}
Implementation Guide © 2017+ HL7 International Community-Based Care and Privacy Work Group hl7.fhir.us.eltss#1.0.0 based on FHIR v4.0.0 generated 2019-09-12.
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