Bundle SurgicalRequestBundleExample of type collection

Entry 1 - fullUrl = http://example.org/fhir/Claim/SurgicalAuthorizationRequestExample

Resource Claim:

Generated Narrative: Claim

Resource Claim "SurgicalAuthorizationRequestExample"

Profile: PAS Claim

LevelOfServiceCode: Elective (1338#E)

Extension Definition for Claim.encounter for Version 5.0: See above (Encounter/SurgicalEncounterExample)

ConditionCode

url

category

value: 07 (1136#07)

url

indicator

value: true

url

code

value: 09 (1321#09)

identifier: id: 16139462398

status: ACTIVE

type: Institutional (Claim Type Codes#institutional)

use: PREAUTHORIZATION

patient: See above (Patient/SubscriberExample)

created: 2020-06-24 07:34:00+0500

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

CareTeams

-	Extension	Sequence	Provider
*		1	See above (PractitionerRole/SurgicalPractitionerRoleExample)

SupportingInfos

-	Sequence	Category	Timing[x]
*	1	Admission Dates (PAS Temporary Codes#admissionDates)	2020-07-02 --> 2020-07-09

Diagnoses

-	Extension	Sequence	Diagnosis[x]
*		1	C18.9 (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#C18.9)

Insurances

-	Sequence	Focal	Coverage
*	1	true	See above (Coverage/InsuranceExample)

Items

-	Extension	Sequence	CareTeamSequence	DiagnosisSequence	Category	ProductOrService	Location[x]
*	, , , ,	1	1	1	Surgical (1365#2)	Under Venous Grafting Only for Coronary Artery Bypass (HCPCSReleaseCodeSets#33510)	21 (CMS Place of Service Codes (POS)#21)

Entry 2 - fullUrl = http://example.org/fhir/Organization/UMOExample

Resource Organization:

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

Contacts

-	Address
*	111 1ST STREET SAN DIEGO CA 92101 US

Entry 3 - fullUrl = http://example.org/fhir/Organization/InsurerExample

Resource Organization:

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

Entry 4 - fullUrl = http://example.org/fhir/Coverage/InsuranceExample

Resource Coverage:

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: ACTIVE

beneficiary: See above (Patient/SubscriberExample)

Entry 5 - fullUrl = http://example.org/fhir/Patient/SubscriberExample

Resource Patient:

JOE SMITH Male, DoB: ( id: 12345678901)

Entry 6 - fullUrl = http://example.org/fhir/Encounter/SurgicalEncounterExample

Resource Encounter:

Not done yet

Entry 7 - fullUrl = http://example.org/fhir/PractitionerRole/SurgicalPractitionerRoleExample

Resource PractitionerRole:

Generated Narrative: PractitionerRole

Resource PractitionerRole "SurgicalPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: Practitioner/ReferralPractitionerExample " WATSON"

location: Location/ReferralLocationExample "REFERRAL CLINIC"

Entry 8 - fullUrl = http://example.org/fhir/Practitioner/SurgicalPractitionerExample

Resource Practitioner:

Generated Narrative: Practitioner

Resource Practitioner "SurgicalPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

Entry 9 - fullUrl = http://example.org/fhir/Location/SurgicalLocationExample

Resource Location:

Generated Narrative: Location

Resource Location "SurgicalLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US