{
  "resourceType" : "Bundle",
  "id" : "ReferralPendingAuthorizationResponseBundleExample",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle"]
  },
  "language" : "en",
  "identifier" : {
    "system" : "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER",
    "value" : "A12345"
  },
  "type" : "collection",
  "timestamp" : "2005-05-02T11:02:00+05:00",
  "entry" : [{
    "fullUrl" : "http://example.org/fhir/ClaimResponse/PractitionerRequestorPendingResponseExample",
    "resource" : {
      "resourceType" : "ClaimResponse",
      "id" : "PractitionerRequestorPendingResponseExample",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_PractitionerRequestorPendingResponseExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse PractitionerRequestorPendingResponseExample</b></p><a name=\"PractitionerRequestorPendingResponseExample\"> </a><a name=\"hcPractitionerRequestorPendingResponseExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-claimresponse.html\">PAS Claim Response</a></p></div><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>created</b>: 2005-05-02 11:02:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>requestor</b>: <a href=\"PractitionerRole-ReferralPractitionerRoleExample.html\">PractitionerRole: telecom = ph: 4029993456</a></p><p><b>request</b>: <a href=\"Claim-ReferralAuthorizationExample.html\">Claim: extension = Urgent,; identifier = urn:trnorg:9012345678#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal</a></p><p><b>outcome</b>: Complete</p><blockquote><p><b>item</b></p><p><b>Administration Reference Number</b>: PEND0001</p><p><b>itemSequence</b>: 1</p><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td></tr></table></blockquote></div>"
      },
      "identifier" : [{
        "system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
        "value" : "111099",
        "assigner" : {
          "identifier" : {
            "system" : "http://example.org/USER_ASSIGNED",
            "value" : "9012345678"
          }
        }
      }],
      "status" : "active",
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
          "code" : "professional"
        }]
      },
      "use" : "preauthorization",
      "patient" : {
        "reference" : "Patient/SubscriberExample"
      },
      "created" : "2005-05-02T11:02:00+05:00",
      "insurer" : {
        "reference" : "Organization/InsurerExample"
      },
      "requestor" : {
        "reference" : "PractitionerRole/ReferralPractitionerRoleExample"
      },
      "request" : {
        "reference" : "Claim/ReferralAuthorizationExample"
      },
      "outcome" : "complete",
      "item" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber",
          "valueString" : "PEND0001"
        }],
        "itemSequence" : 1,
        "adjudication" : [{
          "extension" : [{
            "extension" : [{
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
              "valueCodeableConcept" : {
                "coding" : [{
                  "system" : "https://codesystem.x12.org/005010/306",
                  "code" : "A4",
                  "display" : "Pending"
                }]
              }
            }],
            "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
          }],
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "submitted"
            }]
          }
        }]
      }]
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Organization/UMOExample",
    "resource" : {
      "resourceType" : "Organization",
      "id" : "UMOExample",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"]
      },
      "language" : "en",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_UMOExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization UMOExample</b></p><a name=\"UMOExample\"> </a><a name=\"hcUMOExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-requestor.html\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/6.2.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/8189991234</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/98 X3}\">X3</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>"
      },
      "identifier" : [{
        "system" : "http://hl7.org/fhir/sid/us-npi",
        "value" : "8189991234"
      }],
      "active" : true,
      "type" : [{
        "coding" : [{
          "system" : "https://codesystem.x12.org/005010/98",
          "code" : "X3"
        }]
      }],
      "name" : "DR. JOE SMITH CORPORATION",
      "address" : [{
        "line" : ["111 1ST STREET"],
        "city" : "SAN DIEGO",
        "state" : "CA",
        "postalCode" : "92101",
        "country" : "US"
      }]
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Organization/InsurerExample",
    "resource" : {
      "resourceType" : "Organization",
      "id" : "InsurerExample",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"]
      },
      "language" : "en",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_InsurerExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization InsurerExample</b></p><a name=\"InsurerExample\"> </a><a name=\"hcInsurerExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-insurer.html\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/6.2.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/98 PR}\">PR</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>"
      },
      "identifier" : [{
        "system" : "http://hl7.org/fhir/sid/us-npi",
        "value" : "1234567893"
      }],
      "active" : true,
      "type" : [{
        "coding" : [{
          "system" : "https://codesystem.x12.org/005010/98",
          "code" : "PR"
        }]
      }],
      "name" : "MARYLAND CAPITAL INSURANCE COMPANY"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Patient/SubscriberExample",
    "resource" : {
      "resourceType" : "Patient",
      "id" : "SubscriberExample",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"]
      },
      "language" : "en",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_SubscriberExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient SubscriberExample</b></p><a name=\"SubscriberExample\"> </a><a name=\"hcSubscriberExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-subscriber.html\">PAS Subscriber Patient</a></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"A patient's military status.\"><a href=\"StructureDefinition-extension-militaryStatus.html\">Military Status</a></td><td colspan=\"3\"><span title=\"Codes:{https://codesystem.x12.org/005010/584 RU}\">RU</span></td></tr></table></div>"
      },
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus",
        "valueCodeableConcept" : {
          "coding" : [{
            "system" : "https://codesystem.x12.org/005010/584",
            "code" : "RU"
          }]
        }
      }],
      "identifier" : [{
        "system" : "http://example.org/MIN",
        "value" : "12345678901"
      }],
      "name" : [{
        "family" : "SMITH",
        "given" : ["JOE"]
      }],
      "gender" : "male"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Practitioner/ReferralPractitionerExample",
    "resource" : {
      "resourceType" : "Practitioner",
      "id" : "ReferralPractitionerExample",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner"]
      },
      "language" : "en",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_ReferralPractitionerExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner ReferralPractitionerExample</b></p><a name=\"ReferralPractitionerExample\"> </a><a name=\"hcReferralPractitionerExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-practitioner.html\">PAS Practitioner</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/6.2.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893</p><p><b>name</b>: SUSAN WATSON </p></div>"
      },
      "identifier" : [{
        "system" : "http://hl7.org/fhir/sid/us-npi",
        "value" : "1234567893"
      }],
      "name" : [{
        "family" : "WATSON",
        "given" : ["SUSAN"]
      }]
    }
  }]
}