This page is part of the US Prescription Drug Monitoring Program (PDMP) (v1.0.0: STU1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
{
"resourceType" : "Parameters",
"id" : "pdmp-history-input-parameters-4-delegate",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/pdmp/StructureDefinition/pdmp-parameters-request"
]
},
"parameter" : [
{
"name" : "patient",
"resource" : {
"resourceType" : "Patient",
"id" : "patient-req-4",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/pdmp/StructureDefinition/pdmp-patient"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient: Jules Julien</div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MR",
"display" : "Medical record number"
}
]
},
"system" : "http://highview-va.example.org/mrn",
"value" : "10035666601"
}
],
"active" : true,
"name" : [
{
"family" : "Julien",
"given" : [
"Jules"
]
}
],
"gender" : "female",
"birthDate" : "1980-05-20",
"address" : [
{
"line" : [
"10023 Santa Clara Blvd"
],
"state" : "MA",
"postalCode" : "01742"
}
]
}
},
{
"name" : "authorized-practitioner",
"resource" : {
"resourceType" : "Practitioner",
"id" : "practitioner-req-4",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|6.1.0"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Mari Kimble MD</div>"
},
"identifier" : [
{
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1665015602"
}
],
"name" : [
{
"family" : "Kimble"
}
]
}
},
{
"name" : "authorized-practitioner-role",
"resource" : {
"resourceType" : "PractitionerRole",
"id" : "practitionerrole-req-4",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|6.1.0"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Mari Kimble, Internal Medicine, Highview VA Clinic</div>"
},
"practitioner" : {
"reference" : "Practitioner/practitioner-req-4",
"display" : "Mari Kimble"
},
"organization" : {
"reference" : "Organization/organization-req-4",
"display" : "Highview VA Clinic"
},
"specialty" : [
{
"coding" : [
{
"system" : "http://nucc.org/provider-taxonomy",
"code" : "207R00000X",
"display" : "Internal Medicine Physician"
}
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "508-856-1234"
}
]
}
},
{
"name" : "authorized-practitioner-organization",
"resource" : {
"resourceType" : "Organization",
"id" : "organization-req-4",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|6.1.0"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Highview VA Clinic</div>"
},
"active" : true,
"name" : "Highview VA Clinic",
"telecom" : [
{
"system" : "phone",
"value" : "508-856-5555"
}
],
"address" : [
{
"line" : [
"2002 Highview Ln"
],
"city" : "Worcester",
"state" : "MA",
"postalCode" : "01604"
}
]
}
},
{
"name" : "delegate-practitioner",
"resource" : {
"resourceType" : "Practitioner",
"id" : "practitioner-req-4-del",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|6.1.0"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Boris Bartok</div>"
},
"identifier" : [
{
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1554505606"
}
],
"name" : [
{
"family" : "Bartok"
}
]
}
},
{
"name" : "delegate-practitioner-role",
"resource" : {
"resourceType" : "PractitionerRole",
"id" : "practitionerrole-req-4-del",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|6.1.0"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Boris Bartok RN, Highview VA Clinic</div>"
},
"practitioner" : {
"reference" : "Practitioner/practitioner-req-4-del",
"display" : "Mari Kimble"
},
"organization" : {
"reference" : "Organization/organization-req-4-del",
"display" : "Highview VA Clinic"
},
"specialty" : [
{
"coding" : [
{
"system" : "http://nucc.org/provider-taxonomy",
"code" : "163W00000X",
"display" : "Registered Nurse"
}
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "508-856-9999"
}
]
}
},
{
"name" : "delegate-organization",
"resource" : {
"resourceType" : "Organization",
"id" : "organization-req-4-del",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|6.1.0"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Highview VA Clinic</div>"
},
"active" : true,
"name" : "Highview VA Clinic",
"telecom" : [
{
"system" : "phone",
"value" : "508-856-5555"
}
],
"address" : [
{
"line" : [
"2002 Highview Ln"
],
"city" : "Worcester",
"state" : "MA",
"postalCode" : "01604"
}
]
}
},
{
"name" : "pre-stage-only",
"valueBoolean" : false
}
]
}