Electronic Long-Term Services and Supports (eLTSS) Release 1 - US Realm
2.0.0 - STU2
Electronic Long-Term Services and Supports (eLTSS) Release 1 - US Realm
2.0.0 - STU2
This page is part of the electronic Long-Term Services and Supports Implementation Guide (v2.0.0: STU2) 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
Review JSON and/or XML, as not all elements are rendered by the publisher in the narrative content
Bundle 2039212f3fa5406bb4ffd4a of type collection
Entry 1 - fullUrl = https://hl7.org/fhir/Patient/patientBSJ1
Resource Patient:
Anonymous Patient Female, DoB: 1950-11-01 ( Medical Record Number: United States Medicare Number#10A3D58WH1600 (use: usual))
Entry 2 - fullUrl = https://hl7.org/fhir/CarePlan/careplan1
Resource CarePlan:
ResourceCarePlan "careplan1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: CarePlan_eltss
status: ACTIVE
intent: PLAN
category: Assessment and Plan of Treatment (US Core CarePlan Category Extension Codes#assess-plan)
title: Betsy Smith Johnson's Services and Supports Plan
description: A service and support plan that outlines Betsy's assessed needs, goals, strengths, preferences, and services/providers to meet those needs and goals.
subject: See on this page: Patient/patientBSJ1
period: 2020-05-01 --> 2020-12-31
addresses:
- Condition/need1
- Condition/need2
- Condition/need3
- Condition/need4
supportingInfo:
- See on this page: Observation/strength1
- See on this page: Observation/strength2
- See on this page: Observation/pref1
- See on this page: QuestionnaireResponse/questionnaireresponse1
- See on this page: Contract/contract1
- See on this page: RiskAssessment/risk1
goal:
activity
activity
activity
activity
activity
progress: Betsy will start doing balance exercises ( @2020-05-10)
activity
progress: Betsy working on mobility to dance at son's upcoming wedding ( @2020-05-10)
Entry 3 - fullUrl = https://hl7.org/fhir/Task/Task1
Resource Task:
ResourceTask "Task1"
ServiceRequest Pertains To Goal: See on this page: Goal/goal1
status: READY
intent: ORDER
priority: ROUTINE
code: Fulfill the focal request (Task Codes#fulfill)
description: Perform exercises to improve balance skills.
for: See on this page: Patient/patientBSJ1: Betsy
requester: See on this page: Practitioner/planner1: Mark Planner
Entry 4 - fullUrl = https://hl7.org/fhir/Task/Task2
Resource Task:
ResourceTask "Task2"
ServiceRequest Pertains To Goal: See on this page: Goal/goal2
status: READY
intent: ORDER
priority: ROUTINE
code: Fulfill the focal request (Task Codes#fulfill)
description: Son working with Besty to work on mobility to dance at son's upcoming wedding.
for: See on this page: Patient/patientBSJ1: Betsy
requester: See on this page: Practitioner/planner1: Mark Planner
owner: See on this page: RelatedPerson/son1: Charles - Betsy's son
Entry 5 - fullUrl = https://hl7.org/fhir/Goal/goal2
Resource Goal:
ResourceGoal "goal2" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Goal_eltss
lifecycleStatus: ACCEPTED
description: Dance at son's upcoming wedding ()
Entry 6 - fullUrl = https://hl7.org/fhir/Goal/goal1
Resource Goal:
ResourceGoal "goal1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Goal_eltss
lifecycleStatus: ACCEPTED
description: Improve balance skills ()
Entry 7 - fullUrl = https://hl7.org/fhir/Practitioner/planner1
Resource Practitioner:
Generated Narrative: Practitioner
ResourcePractitioner "planner1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Practitioner_eltss
identifier: United States National Provider Identifier/9941339100,
http://www.acme.org/practitioners/25456name: Mark Planner
telecom: ph: (210) 555 1221
Entry 8 - fullUrl = https://hl7.org/fhir/ServiceRequest/service2
Resource ServiceRequest:
Generated Narrative: ServiceRequest
ResourceServiceRequest "service2" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: ServiceRequest_eltss
status: ACTIVE
intent: PLAN
code: Non-emergency transportation; encounter/trip (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#T2003)
quantity: 2 trips (Details: NCI Thesaurus codeC141286 = 'Transportation')/1 month (Details: UCUM codemo = 'mo')
subject: See on this page: Patient/patientBSJ1
occurrence: 2020-07-01 --> 2020-12-31
performer: See on this page: Organization/provider2a
insurance: See on this page: Coverage/coverage1
supportingInfo: Claim/claim1
note: Service provider will provide a reminder the business day before the trip, and will call when on the way.
Entry 9 - fullUrl = https://hl7.org/fhir/ServiceRequest/service3
Resource ServiceRequest:
Generated Narrative: ServiceRequest
ResourceServiceRequest "service3" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: ServiceRequest_eltss
status: ACTIVE
intent: PLAN
code: Diabetes outpatient self-management training services, individual, per 30 minutes (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#G0108)
quantity: 1 visit (Details: NCI Thesaurus codeC25716 = 'Visit')/1 week (Details: UCUM codewk = 'wk')
subject: See on this page: Patient/patientBSJ1
occurrence: 2020-05-01 --> 2020-08-01
performer: See on this page: Practitioner/provider3
supportingInfo: Claim/claim2
Entry 10 - fullUrl = https://hl7.org/fhir/ServiceRequest/service4
Resource ServiceRequest:
Generated Narrative: ServiceRequest
ResourceServiceRequest "service4" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: ServiceRequest_eltss
status: ACTIVE
intent: PLAN
code: therapeutic exercises to improve balance skills (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#97110)
quantity: 1 visit (Details: NCI Thesaurus codeC25716 = 'Visit')/1 week (Details: UCUM codewk = 'wk')
subject: See on this page: Patient/patientBSJ1
occurrence: 2020-05-01 --> 2020-08-01
performer: See on this page: Practitioner/provider4
supportingInfo:
- Goal/goal1
- Goal/goal2
- Claim/claim3
Entry 11 - fullUrl = https://hl7.org/fhir/RelatedPerson/son1
Resource RelatedPerson:
Generated Narrative: RelatedPerson
ResourceRelatedPerson "son1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: eLTSS RelatedPerson Profile
active: true
patient: See on this page: Patient/patientBSJ1
relationship: son (RoleCode#SONC)
name: Charles Johnson
Entry 12 - fullUrl = https://hl7.org/fhir/Observation/strength1
Resource Observation:
Generated Narrative: Observation
ResourceObservation "strength1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Observation_eltss
status: FINAL
category: Social History (Observation Category Codes#social-history)
code: Strength (eLTSS Observation Codes#strength)
subject: See on this page: Patient/patientBSJ1
effective: 2013-04-02 10:30:10+0100
issued: Apr 3, 2013, 2:30:10 PM
performer: See on this page: Practitioner/caremgr1: Care Manager
value: Able to manage her bills.
Entry 13 - fullUrl = https://hl7.org/fhir/Observation/strength2
Resource Observation:
Generated Narrative: Observation
ResourceObservation "strength2" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Observation_eltss
status: FINAL
category: Social History (Observation Category Codes#social-history)
code: Strength (eLTSS Observation Codes#strength)
subject: See on this page: Patient/patientBSJ1
effective: 2013-04-02 10:30:10+0100
issued: Apr 3, 2013, 2:30:10 PM
performer: See on this page: Practitioner/caremgr1: Care Manager
value: Independent walking with cane.
Entry 14 - fullUrl = https://hl7.org/fhir/Practitioner/caremgr1
Resource Practitioner:
Generated Narrative: Practitioner
ResourcePractitioner "caremgr1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Practitioner_eltss
identifier: United States National Provider Identifier/1144221847,
http://www.acme.org/practitioners/25457name: Sam Monitor
telecom: ph: (210) 224 1599
Entry 15 - fullUrl = https://hl7.org/fhir/CarePlan/careplan2
Resource CarePlan:
ResourceCarePlan "careplan2" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: CarePlan_eltss
partOf: See on this page: CarePlan/careplan1
status: ACTIVE
intent: PLAN
category: Assessment and Plan of Treatment (US Core CarePlan Category Extension Codes#assess-plan)
description: Weather Emergency: A shelf-stable meal is delivered to Meals On Wheels clients. It is to be eaten in the unlikely event of cancellation. Weather meals are donated by the Sheboygan Service Club.
Entry 16 - fullUrl = https://hl7.org/fhir/Claim/claim1
Resource Claim:
ResourceClaim "claim1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Claim_eltss
status: ACTIVE
type: Professional (Claim Type Codes#professional)
use: CLAIM
patient: See on this page: Patient/patientBSJ1
created: 2020-05-01
provider: See on this page: Organization/funding1
priority: Normal (Process Priority Codes#normal)
Insurances
Sequence Focal Coverage 1 true See on this page: Coverage/coverage1 item
sequence: 1
productOrService: T2003 (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#T2003)
UnitPrices
Value Currency 60 USD Nets
Value Currency 600 USD
Entry 17 - fullUrl = https://hl7.org/fhir/Claim/claim2
Resource Claim:
ResourceClaim "claim2" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Claim_eltss
status: ACTIVE
type: Professional (Claim Type Codes#professional)
use: CLAIM
patient: See on this page: Patient/patientBSJ1
created: 2020-05-01
provider: See on this page: Organization/funding1
priority: Normal (Process Priority Codes#normal)
Insurances
Sequence Focal Coverage 1 true See on this page: Coverage/coverage1 item
sequence: 1
productOrService: G0108 (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#G0108)
UnitPrices
Value Currency 55 USD Nets
Value Currency 660 USD
Entry 18 - fullUrl = https://hl7.org/fhir/Claim/claim3
Resource Claim:
ResourceClaim "claim3" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Claim_eltss
status: ACTIVE
type: Professional (Claim Type Codes#professional)
use: CLAIM
patient: See on this page: Patient/patientBSJ1
created: 2020-05-01
provider: See on this page: Organization/funding1
priority: Normal (Process Priority Codes#normal)
Insurances
Sequence Focal Coverage 1 true See on this page: Coverage/coverage1 item
sequence: 1
productOrService: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility (Current Procedural Terminology (CPT®)#97110)
UnitPrices
Value Currency 65 USD Nets
Value Currency 780 USD
Entry 19 - fullUrl = https://hl7.org/fhir/Contract/contract1
Resource Contract:
ResourceContract "contract1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Contract_eltss
signer
type: Patient (Details: Contract Signer Type Codes code PAT = ' Patient ', stated as ' null ')
party: See on this page: Patient/patientBSJ1
Signatures
Type When Who Data Consent Signature (Details: Signature Type Codes code 1.2.840.10065.1.12.1.7 = ' Consent Signature ', stated as ' null ') Apr 2, 2020, 3:00:00 AM See on this page: Patient/patientBSJ1 (base64 data - 187 bytes) signer
type: Guardian (Details: Contract Signer Type Codes code GUARD = ' Guardian ', stated as ' null ')
party: See on this page: RelatedPerson/guardian1
Signatures
Type When Who Data Consent Signature (Details: Signature Type Codes code 1.2.840.10065.1.12.1.7 = ' Consent Signature ', stated as ' null ') Apr 2, 2020, 3:00:00 AM See on this page: RelatedPerson/guardian1 (base64 data - 187 bytes) signer
type: Author (Details: Contract Signer Type Codes code AUT = ' Author ', stated as ' null ')
party: See on this page: Practitioner/planner1
Signatures
Type When Who Data Author's Signature (Details: Signature Type Codes code 1.2.840.10065.1.12.1.1 = ' Author's Signature ', stated as ' null ') Apr 2, 2020, 3:00:00 AM See on this page: Practitioner/planner1 (base64 data - 187 bytes) signer
type: Co-Author (Details: Contract Signer Type Codes code COAUTH = ' Co-Author ', stated as ' null ')
party: See on this page: Practitioner/caremgr1
Signatures
Type When Who Data Author's Signature (Details: Signature Type Codes code 1.2.840.10065.1.12.1.1 = ' Author's Signature ', stated as ' null ') Apr 2, 2020, 3:00:00 AM See on this page: Practitioner/caremgr1 (base64 data - 187 bytes) signer
type: Healthcare Provider (Details: Contract Signer Type Codes code HPROV = ' Healthcare Provider ', stated as ' null ')
party: See on this page: Practitioner/provider3
Signatures
Type When Who Data Consent Signature (Details: Signature Type Codes code 1.2.840.10065.1.12.1.7 = ' Consent Signature ', stated as ' null ') Apr 2, 2020, 3:00:00 AM See on this page: Practitioner/provider3 (base64 data - 187 bytes) signer
type: Healthcare Provider (Details: Contract Signer Type Codes code HPROV = ' Healthcare Provider ', stated as ' null ')
party: See on this page: Practitioner/provider2b
Signatures
Type When Who Data Consent Signature (Details: Signature Type Codes code 1.2.840.10065.1.12.1.7 = ' Consent Signature ', stated as ' null ') Apr 2, 2020, 3:00:00 AM See on this page: Practitioner/provider2b (base64 data - 187 bytes) signer
type: Healthcare Provider (Details: Contract Signer Type Codes code HPROV = ' Healthcare Provider ', stated as ' null ')
party: See on this page: RelatedPerson/son1
Signatures
Type When Who Data Consent Signature (Details: Signature Type Codes code 1.2.840.10065.1.12.1.7 = ' Consent Signature ', stated as ' null ') Apr 2, 2020, 3:00:00 AM See on this page: RelatedPerson/son1 (base64 data - 187 bytes) signer
type: Healthcare Provider (Details: Contract Signer Type Codes code HPROV = ' Healthcare Provider ', stated as ' null ')
party: See on this page: Practitioner/provider4
Signatures
Type When Who Data Consent Signature (Details: Signature Type Codes code 1.2.840.10065.1.12.1.7 = ' Consent Signature ', stated as ' null ') Apr 2, 2020, 3:00:00 AM See on this page: Practitioner/provider4 (base64 data - 187 bytes)
Entry 20 - fullUrl = https://hl7.org/fhir/Coverage/coverage1
Resource Coverage:
ResourceCoverage "coverage1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
status: ACTIVE
beneficiary: See on this page: Patient/patientBSJ1
Entry 21 - fullUrl = https://hl7.org/fhir/EpisodeOfCare/episode1
Resource EpisodeOfCare:
Generated Narrative: EpisodeOfCare
ResourceEpisodeOfCare "episode1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: EpisodeOfCare_eltss
status: ACTIVE
patient: See on this page: Patient/patientBSJ1
careManager: See on this page: Practitioner/caremgr1
Entry 22 - fullUrl = https://hl7.org/fhir/Organization/funding1
Resource Organization:
Generated Narrative: Organization
ResourceOrganization "funding1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: US Core Organization Profile
identifier: United States National Provider Identifier/1144221847, Clinical Laboratory Improvement Amendments/12D4567890
active: true
name: Texas Department of Community Health
Contacts
Address 7430 Louis Pasteur Dr, San Antonio, TX 78229
Entry 23 - fullUrl = https://hl7.org/fhir/RelatedPerson/guardian1
Resource RelatedPerson:
Generated Narrative: RelatedPerson
ResourceRelatedPerson "guardian1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: eLTSS RelatedPerson Profile
active: true
patient: See on this page: Patient/patientBSJ1
relationship: guardian (RoleCode#GUARD)
name: Charles Johnson
Entry 24 - fullUrl = https://hl7.org/fhir/Location/location1
Resource Location:
ResourceLocation "location1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Location_eltss
name: In Home
address: 111 Maple Ct, San Antonio, TX 78212
Entry 25 - fullUrl = https://hl7.org/fhir/Condition/need1
Resource Condition:
Generated Narrative: Condition
ResourceCondition "need1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Condition_eltss
clinicalStatus: Active (Condition Clinical Status Codes#active)
verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)
category: Health Concern (US Core Condition Category Extension Codes#health-concern), Assessed Need (eLTSS Condition Category Codes#assessed-need), SDOH (US Core Category#sdoh)
code: Needs transportation (SNOMED CT#713458007 "Lack of access to transportation (finding)")
Entry 26 - fullUrl = https://hl7.org/fhir/Condition/need2
Resource Condition:
Generated Narrative: Condition
ResourceCondition "need2" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Condition_eltss
clinicalStatus: Active (Condition Clinical Status Codes#active)
verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)
category: Health Concern (US Core Condition Category Extension Codes#health-concern), Assessed Need (eLTSS Condition Category Codes#assessed-need)
code: Needs health / nutrition education for diabetes (SNOMED CT#734920002 "Diabetes mellitus education service")
Entry 27 - fullUrl = https://hl7.org/fhir/Condition/need3
Resource Condition:
Generated Narrative: Condition
ResourceCondition "need3" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Condition_eltss
clinicalStatus: Active (Condition Clinical Status Codes#active)
verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)
category: Health Concern (US Core Condition Category Extension Codes#health-concern), Assessed Need (eLTSS Condition Category Codes#assessed-need), Cognitive Status (US Core Category#cognitive-status)
code: Depression (on treatment) (SNOMED CT#35489007 "Depressive disorder (disorder)")
Entry 28 - fullUrl = https://hl7.org/fhir/Condition/need4
Resource Condition:
Generated Narrative: Condition
ResourceCondition "need4" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Condition_eltss
Condition Due To: See on this page: Condition/need3
clinicalStatus: Active (Condition Clinical Status Codes#active)
verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)
category: Health Concern (US Core Condition Category Extension Codes#health-concern), Assessed Need (eLTSS Condition Category Codes#assessed-need), SDOH (US Core Category#sdoh)
code: Needs physical exercises (SNOMED CT#183301007 "Physical exercises (regime/therapy)")
Entry 29 - fullUrl = https://hl7.org/fhir/Observation/pref1
Resource Observation:
Generated Narrative: Observation
ResourceObservation "pref1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Observation_eltss
status: FINAL
category: Social History (Observation Category Codes#social-history)
code: Care experience preference (LOINC#95541-9)
subject: See on this page: Patient/patientBSJ1
effective: 2013-04-02 10:30:10+0100
issued: Apr 3, 2013, 2:30:10 PM
performer: See on this page: Practitioner/caremgr1: Care Manager
value: Accessing the ICWP Waiver for her current service needs, and would like to remain on ICWP and continue with her current services.
Entry 30 - fullUrl = https://hl7.org/fhir/Organization/provider2a
Resource Organization:
Generated Narrative: Organization
ResourceOrganization "provider2a" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: US Core Organization Profile
identifier: United States National Provider Identifier/1144221847, Clinical Laboratory Improvement Amendments/12D4567890
active: true
name: The Transporter, Inc.
Contacts
Telecom Address ph: (210) 555 1313 111 Business Street, San Antonio, TX 78212
Entry 31 - fullUrl = https://hl7.org/fhir/Practitioner/provider2b
Resource Practitioner:
Generated Narrative: Practitioner
ResourcePractitioner "provider2b" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Practitioner_eltss
identifier:
http://www.acme.org/practitioners/11223344name: Bill Driver
telecom: ph: (210) 111 2222
Entry 32 - fullUrl = https://hl7.org/fhir/Practitioner/provider3
Resource Practitioner:
Generated Narrative: Practitioner
ResourcePractitioner "provider3" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Practitioner_eltss
identifier:
http://www.acme.org/practitioners/987654name: Lisa Educator
telecom: ph: (210) 555 1213
Entry 33 - fullUrl = https://hl7.org/fhir/Practitioner/provider4
Resource Practitioner:
Generated Narrative: Practitioner
ResourcePractitioner "provider4" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Practitioner_eltss
identifier:
http://www.acme.org/practitioners/987657name: Norma Trainer
telecom: ph: (210) 555 1214
Entry 34 - fullUrl = https://hl7.org/fhir/PractitionerRole/PractitionerRole-1
Resource PractitionerRole:
Generated Narrative: PractitionerRole
ResourcePractitionerRole "PractitionerRole-1"
Profile: eLTSS PractitionerRole Profile
practitioner: See on this page: Practitioner/caremgr1: Sam Monitor
organization: See on this page: Organization/funding1: Texas Department of Community Health
code: Community Health Worker (provider-taxonomy#172V00000X)
specialty: Case Manager/Care Coordinator (provider-taxonomy#171M00000X)
location: See on this page: Location/communitysite: Health Level Seven International
Entry 35 - fullUrl = https://hl7.org/fhir/Location/communitysite
Resource Location:
ResourceLocation "communitysite" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Location_eltss
name: In Home
address: 7430 Louis Pasteur Dr, San Antonio, TX 78229
Entry 36 - fullUrl = https://hl7.org/fhir/Questionnaire/questionnaire1
Resource Questionnaire:
LinkID Text Cardinality Type Description & Constraints Questionnaire1
Questionnaire http://hl7.org/fhir/us/eltss/Questionnaire/questionnaire1 q1
Did you choose the setting in which you reside? 0..1 boolean q2
What alternative home and community-based settings were considered? 0..1 string Were you given a choice of services outlined in the plan? 0..1 boolean Did you participate in the selection of services outlined in the plan? 0..1 boolean Do you agree to the services outlined in the plan? 0..1 boolean Were you offered a choice of providers for each service? 0..1 boolean Do you feel you made an informed choice in selecting the provider for each service? 0..1 boolean Documentation for this format
Entry 37 - fullUrl = https://hl7.org/fhir/QuestionnaireResponse/questionnaireresponse1
Resource QuestionnaireResponse:
LinkID Text Definition Answer QuestionnaireResponse
Entry 38 - fullUrl = https://hl7.org/fhir/RiskAssessment/risk1
Resource RiskAssessment:
Generated Narrative: RiskAssessment
ResourceRiskAssessment "risk1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: RiskAssessment_eltss
RiskPlan: : This points to a management plan for any risks. This is not the backup plan, which is an alternative plan for the CarePlan. The risk management plan is meant to help avoid needing the backup plan.
status: FINAL
subject: See on this page: Patient/patientBSJ1
prediction
outcome: At risk for falls (finding) (SNOMED CT#129839007)
prediction
outcome: At risk of stroke (SNOMED CT#866240007)
mitigation: Betsy is at risk for falls and of having a stroke. Her risk is increased due to her depression medication. She has grab bars installed in the shower and is working on her balance with a trainer.
Entry 39 - fullUrl = https://hl7.org/fhir/ServiceRequest/service1
Resource ServiceRequest:
Generated Narrative: ServiceRequest
ResourceServiceRequest "service1" Version"1" Updated"2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: ServiceRequest_eltss
Eltss_directedBy: self ()
status: ACTIVE
intent: PLAN
code: Bath tub wall rail, each (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#E0241)
quantity: 1 install (Details: NCI Thesaurus codeC81906 = 'Deploy')
subject: See on this page: Patient/patientBSJ1
occurrence: 2020-05-01 --> 2020-12-31
performer: See on this page: RelatedPerson/son1
supportingInfo: RiskAssessment/risk1
IG © 2020+ HL7 International / Human and Social Services. Package hl7.fhir.us.eltss#2.0.0 based on FHIR 4.0.1. Generated 2024-05-27
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