{ "resourceType" : "Bundle", "id" : "04afa000-48a5-4fb2-8707-6a43af045868", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-as-enrollment-bundle"] }, "identifier" : { "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "RI", "display" : "Resource identifier" }] }, "system" : "http://tailormed.co", "value" : "6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2", "assigner" : { "display" : "TailorMed" } }, "type" : "message", "timestamp" : "2024-04-02T08:10:13-05:00", "entry" : [{ "fullUrl" : "urn:uuid:9e592049-0434-48f9-8498-d7cf1e80e086", "resource" : { "resourceType" : "MessageHeader", "id" : "9e592049-0434-48f9-8498-d7cf1e80e086", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: MessageHeader 9e592049-0434-48f9-8498-d7cf1e80e086

Profile: UAPI MessageHeader

event: uapi-event-type enrollment-with-consent: enrollment-with-consent

Destinations

-NameEndpoint
*UAPI-ENR-V2.1https://test-us-e1.apis.roche.com/pharma-cmg-ehr-fhir-exp-test/v2/enrollment

sender: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

Sources

-NameEndpoint
*TailorMedhttp://tailormed.co/fhir/enrollmentID/ENR-00001

focus: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

" }, "eventCoding" : { "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type", "code" : "enrollment-with-consent" }, "destination" : [{ "name" : "UAPI-ENR-V2.1", "endpoint" : "https://test-us-e1.apis.roche.com/pharma-cmg-ehr-fhir-exp-test/v2/enrollment" }], "sender" : { "reference" : "urn:uuid:7e45cd4c-8c11-4205-a2b7-fce834bc3511", "type" : "Organization" }, "source" : { "name" : "TailorMed", "endpoint" : "http://tailormed.co/fhir/enrollmentID/ENR-00001" }, "focus" : [{ "reference" : "urn:uuid:7cd8694a-0268-414e-b8ca-9271e7e1a242", "type" : "List" }] } }, { "fullUrl" : "urn:uuid:7cd8694a-0268-414e-b8ca-9271e7e1a242", "resource" : { "resourceType" : "List", "id" : "7cd8694a-0268-414e-b8ca-9271e7e1a242", "text" : { "status" : "generated", "div" : "

Generated Narrative: List 7cd8694a-0268-414e-b8ca-9271e7e1a242

messageContext

Mode: Change List Status: Current
Items
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
" }, "status" : "current", "mode" : "changes", "title" : "messageContext", "entry" : [{ "item" : { "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" } }, { "item" : { "reference" : "urn:uuid:7e45cd4c-8c11-4205-a2b7-fce834bc3511", "type" : "Organization" } }, { "item" : { "reference" : "urn:uuid:3c5298d3-2b49-4f79-b703-a46623899258", "type" : "Practitioner" } }, { "item" : { "reference" : "urn:uuid:42b41bdb-1781-49aa-a091-78cdd92129df", "type" : "Coverage" } }, { "item" : { "reference" : "urn:uuid:46d09721-f04e-4059-871f-31a1dc5127cf", "type" : "RelatedPerson" } }, { "item" : { "reference" : "urn:uuid:af15ccf2-4e36-400f-8e74-24fbcf29dfbd", "type" : "QuestionnaireResponse" } }, { "item" : { "reference" : "urn:uuid:bc20c5ea-f639-4221-ab61-ce75c5e64aba", "type" : "Condition" } }, { "item" : { "reference" : "urn:uuid:645c7756-d1d7-4df2-a65d-e1680dbbb991", "type" : "Consent" } }, { "item" : { "reference" : "urn:uuid:4f536bc9-a238-49ac-bf07-65d670f84ed3", "type" : "Consent" } }, { "item" : { "reference" : "urn:uuid:1cc390ba-32b3-4c41-a805-d4b9cee64784", "type" : "Provenance" } }, { "item" : { "reference" : "urn:uuid:212c57ad-45cd-4882-87e7-8415ded3db05", "type" : "ServiceRequest" } }, { "item" : { "reference" : "urn:uuid:f71a66c4-f747-4b46-8adc-875a45f8ee7e", "type" : "ServiceRequest" } }, { "item" : { "reference" : "urn:uuid:e9d05dcd-bb02-4a08-af63-386dcab3f160", "type" : "MedicationRequest" } }, { "item" : { "reference" : "urn:uuid:d1654255-0a8d-4f2c-9405-19a6794500a2", "type" : "Organization" } }, { "item" : { "reference" : "urn:uuid:d1089cdf-7a5f-45b1-99b9-2c021eca5270", "type" : "Organization" } }] } }, { "fullUrl" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "resource" : { "resourceType" : "Patient", "id" : "ab45810f-2057-4b15-a24d-be929071cad5", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-patient"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Patient ab45810f-2057-4b15-a24d-be929071cad5

Profile: UAPI Patient

Rudy Gandoff (official) Male, DoB: 1965-10-29 ( Patient internal identifier: TM-2345\u00a0(use:\u00a0official,\u00a0))

Contact Detail
  • ph: 6501231234(Home)
  • ph: 6504561234(Mobile)
  • rudyg@example.com
  • 1234 Airport Blvd South San Francisco CA 94080 US
Language:English (preferred)
Links:
" }, "identifier" : [{ "use" : "official", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "PI", "display" : "Patient internal identifier" }] }, "system" : "http://tailormed.co", "value" : "TM-2345", "assigner" : { "display" : "TailorMed" } }], "name" : [{ "use" : "official", "family" : "Gandoff", "given" : ["Rudy"] }], "telecom" : [{ "system" : "phone", "value" : "6501231234", "use" : "home", "rank" : 1 }, { "system" : "phone", "value" : "6504561234", "use" : "mobile", "rank" : 2 }, { "system" : "email", "value" : "rudyg@example.com", "use" : "home", "rank" : 3 }], "gender" : "male", "birthDate" : "1965-10-29", "address" : [{ "line" : ["1234 Airport Blvd"], "city" : "South San Francisco", "state" : "CA", "postalCode" : "94080", "country" : "US" }], "communication" : [{ "language" : { "coding" : [{ "system" : "urn:ietf:bcp:47", "code" : "en", "display" : "English" }] }, "preferred" : true }], "generalPractitioner" : [{ "reference" : "urn:uuid:3c5298d3-2b49-4f79-b703-a46623899258" }], "managingOrganization" : { "reference" : "urn:uuid:7e45cd4c-8c11-4205-a2b7-fce834bc3511" } } }, { "fullUrl" : "urn:uuid:7e45cd4c-8c11-4205-a2b7-fce834bc3511", "resource" : { "resourceType" : "Organization", "id" : "7e45cd4c-8c11-4205-a2b7-fce834bc3511", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-organization"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization 7e45cd4c-8c11-4205-a2b7-fce834bc3511

Profile: UAPI Organization

identifier: http://tailormed.co/HCP-01\u00a0(use:\u00a0usual,\u00a0)

type: Healthcare Provider

name: TANNER CLINIC MURRAY

telecom: venus@tannerclinic.com

address: 5296 S COMMERCE DR Murray UT 84107 US

contact

name: Venus Yardav (Official)

telecom: ph: 8882704882(Work), fax: 8179974042(Work)

" }, "identifier" : [{ "use" : "usual", "system" : "http://tailormed.co", "value" : "HCP-01", "assigner" : { "display" : "TailorMed" } }], "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/organization-type", "code" : "prov", "display" : "Healthcare Provider" }] }], "name" : "TANNER CLINIC MURRAY", "telecom" : [{ "system" : "email", "value" : "venus@tannerclinic.com" }], "address" : [{ "line" : ["5296 S COMMERCE DR"], "city" : "Murray", "state" : "UT", "postalCode" : "84107", "country" : "US" }], "contact" : [{ "name" : { "use" : "official", "family" : "Yardav", "given" : ["Venus"] }, "telecom" : [{ "system" : "phone", "value" : "8882704882", "use" : "work", "rank" : 1 }, { "system" : "fax", "value" : "8179974042", "use" : "work", "rank" : 2 }] }] } }, { "fullUrl" : "urn:uuid:3c5298d3-2b49-4f79-b703-a46623899258", "resource" : { "resourceType" : "Practitioner", "id" : "3c5298d3-2b49-4f79-b703-a46623899258", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Practitioner 3c5298d3-2b49-4f79-b703-a46623899258

Profile: UAPI Practitioner

identifier: National provider identifier/1659533669\u00a0(use:\u00a0official,\u00a0)

name: RAFAEL FIRSZT (Official)

" }, "identifier" : [{ "use" : "official", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "NPI", "display" : "National provider identifier" }] }, "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "1659533669" }], "name" : [{ "use" : "official", "family" : "FIRSZT", "given" : ["RAFAEL"] }] } }, { "fullUrl" : "urn:uuid:42b41bdb-1781-49aa-a091-78cdd92129df", "resource" : { "resourceType" : "Coverage", "id" : "42b41bdb-1781-49aa-a091-78cdd92129df", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Coverage 42b41bdb-1781-49aa-a091-78cdd92129df

Profile: UAPI Coverage

status: Active

type: health insurance plan policy

subscriber: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

subscriberId: 4353

beneficiary: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

payor: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

Classes

-TypeValueName
*Group12344frgrGroup Number

order: 1

network: Dakotacare

" }, "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code" : "HIP", "display" : "health insurance plan policy" }] }, "subscriber" : { "reference" : "urn:uuid:46d09721-f04e-4059-871f-31a1dc5127cf", "type" : "RelatedPerson" }, "subscriberId" : "4353", "beneficiary" : { "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" }, "payor" : [{ "reference" : "urn:uuid:d1654255-0a8d-4f2c-9405-19a6794500a2", "type" : "Organization" }], "class" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/coverage-class", "code" : "group", "display" : "Group" }] }, "value" : "12344frgr", "name" : "Group Number" }], "order" : 1, "network" : "Dakotacare" } }, { "fullUrl" : "urn:uuid:46d09721-f04e-4059-871f-31a1dc5127cf", "resource" : { "resourceType" : "RelatedPerson", "id" : "46d09721-f04e-4059-871f-31a1dc5127cf", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: RelatedPerson 46d09721-f04e-4059-871f-31a1dc5127cf

Profile: UAPI RelatedPerson

patient: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

relationship: significant other

name: Rebecca Gandoff (Official)

telecom: ph: 6504567890(Mobile)

birthDate: 1972-10-29

" }, "patient" : { "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" }, "relationship" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "code" : "SIGOTHR", "display" : "significant other" }] }], "name" : [{ "use" : "official", "family" : "Gandoff", "given" : ["Rebecca"] }], "telecom" : [{ "system" : "phone", "value" : "6504567890", "use" : "mobile" }], "birthDate" : "1972-10-29" } }, { "fullUrl" : "urn:uuid:af15ccf2-4e36-400f-8e74-24fbcf29dfbd", "resource" : { "resourceType" : "QuestionnaireResponse", "id" : "af15ccf2-4e36-400f-8e74-24fbcf29dfbd", "text" : { "status" : "generated", "div" : "

Generated Narrative: QuestionnaireResponse af15ccf2-4e36-400f-8e74-24fbcf29dfbd

\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIDTextDefinitionAnswer\"doco\"
\".\"\".\" af15ccf2-4e36-400f-8e74-24fbcf29dfbdQuestionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234
\".\"\".\"\".\" authorizationAuthorization #3333333333
\".\"\".\"\".\" xolair-prescription-typeWhat is the Prescription Type?Naive/new start
\".\"\".\"\".\" xolair-have-moderate-to-severe-persistent-aaDoes the patient have moderate to severe persistent allergic asthma?Yes
\".\"\".\"\".\" xolair-positive-skin-or-rast-test-to-a-perennial-aeroallergenDoes the patient have a history of positive skin or RAST test to a perennial aeroallergen?Yes
\".\"\".\"\".\" xolair-have-symptoms-inadequately-controlled-with-icsDoes the patient have symptoms inadequately controlled with ICS?Yes
\".\"\".\"\".\" xolair-ige-mediated-faDoes the Patient have a clinical history consistent with IgE-mediated food allergy?No
\".\"\".\"\".\" site-of-treatmentSite of TreatmentBundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
\".\"\".\"\".\" contact-patientDo not contact patientYes
\".\"\".\"\".\" xolair-ige-level-iumlWhat is the patient's IgE level (IU/mL)?200
\".\"\".\"\".\" adotAnticipated Date of Treatment (Optional)2024-04-30
\".\"\".\"\".\" dispensing-throughDispensing Through:Specialty Pharmacy
\".\"\".\"\".\" dispenseDispense:Prefilled Syringe
\".\"\".\"\".\" ship-to-2C&R Ship ToSite of Treatment
\".\"\".\"\".\" detailed-messageOk to leave a detailed message?Yes
\".\"\".\"\".\" has-treatment-startedHas treatment started?Yes
\".\"\".\"\".\" posPlace of ServiceInfusion Center
\".\"\".\"\".\" preferred-sp-optionalPreferred Specialty Pharmacy (Optional)RX Crossroads
\".\"\".\"\".\" pa-in-placeIs prior authorization in place?Yes
\".\"\".\"\".\" prescription-planIs this a Prescription plan?No
\".\"\".\"\".\" re-verify-benefits-at-pa-expirationRe-verify benefits at PA expirationYes
\".\"\".\"\".\" xolair-weight-kgWeight (kg)50
\".\"\".\"\".\" tcpa-consentTCPA Consent Provided?No

\"doco\" Documentation for this format
" }, "questionnaire" : "https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234", "status" : "completed", "subject" : { "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" }, "item" : [{ "linkId" : "authorization", "text" : "Authorization #", "answer" : [{ "valueString" : "3333333333" }] }, { "linkId" : "xolair-prescription-type", "text" : "What is the Prescription Type?", "answer" : [{ "valueString" : "Naive/new start" }] }, { "linkId" : "xolair-have-moderate-to-severe-persistent-aa", "text" : "Does the patient have moderate to severe persistent allergic asthma?", "answer" : [{ "valueString" : "Yes" }] }, { "linkId" : "xolair-positive-skin-or-rast-test-to-a-perennial-aeroallergen", "text" : "Does the patient have a history of positive skin or RAST test to a perennial aeroallergen?", "answer" : [{ "valueString" : "Yes" }] }, { "linkId" : "xolair-have-symptoms-inadequately-controlled-with-ics", "text" : "Does the patient have symptoms inadequately controlled with ICS?", "answer" : [{ "valueString" : "Yes" }] }, { "linkId" : "xolair-ige-mediated-fa", "text" : "Does the Patient have a clinical history consistent with IgE-mediated food allergy?", "answer" : [{ "valueString" : "No" }] }, { "linkId" : "site-of-treatment", "text" : "Site of Treatment", "answer" : [{ "valueReference" : { "reference" : "urn:uuid:d1089cdf-7a5f-45b1-99b9-2c021eca5270", "type" : "Organization" } }] }, { "linkId" : "contact-patient", "text" : "Do not contact patient", "answer" : [{ "valueString" : "Yes" }] }, { "linkId" : "xolair-ige-level-iuml", "text" : "What is the patient's IgE level (IU/mL)?", "answer" : [{ "valueDecimal" : 200 }] }, { "linkId" : "adot", "text" : "Anticipated Date of Treatment (Optional)", "answer" : [{ "valueDate" : "2024-04-30" }] }, { "linkId" : "dispensing-through", "text" : "Dispensing Through:", "answer" : [{ "valueString" : "Specialty Pharmacy" }] }, { "linkId" : "dispense", "text" : "Dispense:", "answer" : [{ "valueString" : "Prefilled Syringe" }] }, { "linkId" : "ship-to-2", "text" : "C&R Ship To", "answer" : [{ "valueString" : "Site of Treatment" }] }, { "linkId" : "detailed-message", "text" : "Ok to leave a detailed message?", "answer" : [{ "valueString" : "Yes" }] }, { "linkId" : "has-treatment-started", "text" : "Has treatment started?", "answer" : [{ "valueString" : "Yes" }] }, { "linkId" : "pos", "text" : "Place of Service", "answer" : [{ "valueString" : "Infusion Center" }] }, { "linkId" : "preferred-sp-optional", "text" : "Preferred Specialty Pharmacy (Optional)", "answer" : [{ "valueString" : "RX Crossroads" }] }, { "linkId" : "pa-in-place", "text" : "Is prior authorization in place?", "answer" : [{ "valueString" : "Yes" }] }, { "linkId" : "prescription-plan", "text" : "Is this a Prescription plan?", "answer" : [{ "valueString" : "No" }] }, { "linkId" : "re-verify-benefits-at-pa-expiration", "text" : "Re-verify benefits at PA expiration", "answer" : [{ "valueString" : "Yes" }] }, { "linkId" : "xolair-weight-kg", "text" : "Weight (kg)", "answer" : [{ "valueDecimal" : 50 }] }, { "linkId" : "tcpa-consent", "text" : "TCPA Consent Provided?", "answer" : [{ "valueString" : "No" }] }] } }, { "fullUrl" : "urn:uuid:bc20c5ea-f639-4221-ab61-ce75c5e64aba", "resource" : { "resourceType" : "Condition", "id" : "bc20c5ea-f639-4221-ab61-ce75c5e64aba", "text" : { "status" : "generated", "div" : "

Generated Narrative: Condition bc20c5ea-f639-4221-ab61-ce75c5e64aba

code: Severe persistent asthma, uncomplicated

subject: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

" }, "code" : { "coding" : [{ "system" : "http://hl7.org/fhir/sid/icd-10-cm", "code" : "J45.50" }] }, "subject" : { "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" } } }, { "fullUrl" : "urn:uuid:645c7756-d1d7-4df2-a65d-e1680dbbb991", "resource" : { "resourceType" : "Consent", "id" : "645c7756-d1d7-4df2-a65d-e1680dbbb991", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-consent"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Consent 645c7756-d1d7-4df2-a65d-e1680dbbb991

Profile: UAPI Consent

status: Active

scope: Privacy Consent

category: Patient Authorization Signature

patient: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

dateTime: 2024-04-02 16:24:45+0000

performer: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

policyRule: HIPAA Authorization

Provisions

-Type
*Opt In
" }, "status" : "active", "scope" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/consentscope", "code" : "patient-privacy", "display" : "Privacy Consent" }] }, "category" : [{ "coding" : [{ "system" : "http://loinc.org", "code" : "59284-0", "display" : "Patient Authorization Signature" }] }], "patient" : { "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" }, "dateTime" : "2024-04-02T16:24:45Z", "performer" : [{ "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" }], "policyRule" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/consentpolicycodes", "code" : "hipaa-auth", "display" : "HIPAA Authorization" }] }, "provision" : { "type" : "permit" } } }, { "fullUrl" : "urn:uuid:4f536bc9-a238-49ac-bf07-65d670f84ed3", "resource" : { "resourceType" : "Consent", "id" : "4f536bc9-a238-49ac-bf07-65d670f84ed3", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-consent"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Consent 4f536bc9-a238-49ac-bf07-65d670f84ed3

Profile: UAPI Consent

status: Active

scope: Privacy Consent

category: Prescriber Signature

patient: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

dateTime: 2024-04-02 16:24:45+0000

performer: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

policyRule: HIPAA Authorization

Provisions

-Type
*Opt In
" }, "status" : "active", "scope" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/consentscope", "code" : "patient-privacy", "display" : "Privacy Consent" }] }, "category" : [{ "coding" : [{ "system" : "http://loinc.org", "code" : "59284-0", "display" : "Prescriber Signature" }] }], "patient" : { "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" }, "dateTime" : "2024-04-02T16:24:45Z", "performer" : [{ "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" }], "policyRule" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/consentpolicycodes", "code" : "hipaa-auth", "display" : "HIPAA Authorization" }] }, "provision" : { "type" : "permit" } } }, { "fullUrl" : "urn:uuid:1cc390ba-32b3-4c41-a805-d4b9cee64784", "resource" : { "resourceType" : "Provenance", "id" : "1cc390ba-32b3-4c41-a805-d4b9cee64784", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-provenance"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Provenance 1cc390ba-32b3-4c41-a805-d4b9cee64784

Profile: UAPI Provenance

Provenance for Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

Summary

Recorded2024-04-02 09:49:39+0000

Agents

who
Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
" }, "target" : [{ "reference" : "urn:uuid:4f536bc9-a238-49ac-bf07-65d670f84ed3", "type" : "Consent" }], "recorded" : "2024-04-02T09:49:39.382941+00:00", "agent" : [{ "who" : { "reference" : "urn:uuid:3c5298d3-2b49-4f79-b703-a46623899258", "type" : "Practitioner" } }], "signature" : [{ "type" : [{ "system" : "urn:iso-astm:E1762-95:2013", "code" : "1.2.840.10065.1.12.1.7", "display" : "Consent Signature" }], "when" : "2024-04-02T09:49:39.382897+00:00", "who" : { "reference" : "urn:uuid:3c5298d3-2b49-4f79-b703-a46623899258", "type" : "Practitioner" }, "sigFormat" : "image/*", "data" : "bQ==" }] } }, { "fullUrl" : "urn:uuid:212c57ad-45cd-4882-87e7-8415ded3db05", "resource" : { "resourceType" : "ServiceRequest", "id" : "212c57ad-45cd-4882-87e7-8415ded3db05", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-servicerequest"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: ServiceRequest 212c57ad-45cd-4882-87e7-8415ded3db05

Profile: UAPI ServiceRequest

status: Active

intent: Order

code: Benefit Investigation / Prior Authorization

subject: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

" }, "status" : "active", "intent" : "order", "code" : { "coding" : [{ "system" : "https://fhir.developer.gene.com/CodeSystem/uapi-sr-type", "code" : "bipa" }] }, "subject" : { "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" } } }, { "fullUrl" : "urn:uuid:f71a66c4-f747-4b46-8adc-875a45f8ee7e", "resource" : { "resourceType" : "ServiceRequest", "id" : "f71a66c4-f747-4b46-8adc-875a45f8ee7e", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-servicerequest"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: ServiceRequest f71a66c4-f747-4b46-8adc-875a45f8ee7e

Profile: UAPI ServiceRequest

status: Active

intent: Order

code: Starter

subject: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

" }, "status" : "active", "intent" : "order", "code" : { "coding" : [{ "system" : "https://fhir.developer.gene.com/CodeSystem/uapi-sr-type", "code" : "starter" }] }, "subject" : { "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" } } }, { "fullUrl" : "urn:uuid:e9d05dcd-bb02-4a08-af63-386dcab3f160", "resource" : { "resourceType" : "MedicationRequest", "id" : "e9d05dcd-bb02-4a08-af63-386dcab3f160", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-medicationrequest"] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: MedicationRequest e9d05dcd-bb02-4a08-af63-386dcab3f160

Profile: UAPI MedicationRequest

status: Active

intent: Order

medication: Xolair

subject: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

requester: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

courseOfTherapyType: Starter (Pre filled Syringe)

insurance: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500

note:

Allergic Asthma - 300mg/dose every 2 weeks

\n

dosageInstruction

timing: Once per 2 weeks

DoseAndRates

-Dose[x]
*300 mg

dispenseRequest

UAPI MedicationRequest Dispenser Instructions:

Dispense Instruction: Quantity 5 of 300mg prefilled syringe(s), Quantity 2 of 75 mg prefilled syringe(s) and Quantity 1 of 150 mg prefilled syringe(s)

\n

UAPI MedicationRequest Dispense Quantity Detailed Breakdown

  • dispenseQuantity: 5
  • dispenseUnit: 300mg prefilled syringe(s)

UAPI MedicationRequest Dispense Quantity Detailed Breakdown

  • dispenseQuantity: 2
  • dispenseUnit: 75mg prefilled syringe(s)

UAPI MedicationRequest Dispense Quantity Detailed Breakdown

  • dispenseQuantity: 1
  • dispenseUnit: 150 mg prefilled syringe(s)

numberOfRepeatsAllowed: 1

ExpectedSupplyDurations

-ValueUnitSystemCode
*90dhttp://unitsofmeasure.orgd
" }, "status" : "active", "intent" : "order", "medicationCodeableConcept" : { "coding" : [{ "system" : "https://fhir.developer.gene.com/CodeSystem/uapi-product-name", "code" : "xolair", "display" : "Xolair" }] }, "subject" : { "reference" : "urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5", "type" : "Patient" }, "requester" : { "reference" : "urn:uuid:3c5298d3-2b49-4f79-b703-a46623899258", "type" : "Practitioner" }, "courseOfTherapyType" : { "text" : "Starter (Pre filled Syringe)" }, "insurance" : [{ "reference" : "urn:uuid:42b41bdb-1781-49aa-a091-78cdd92129df", "type" : "Coverage" }], "note" : [{ "text" : "Allergic Asthma - 300mg/dose every 2 weeks" }], "dosageInstruction" : [{ "timing" : { "repeat" : { "frequency" : 1, "period" : 2, "periodUnit" : "wk" } }, "doseAndRate" : [{ "doseQuantity" : { "value" : 300, "unit" : "mg" } }] }], "dispenseRequest" : { "extension" : [{ "url" : "https://fhir.developer.gene.com/StructureDefinition/dispenser-instruction", "valueAnnotation" : { "text" : "Dispense Instruction: Quantity 5 of 300mg prefilled syringe(s), Quantity 2 of 75 mg prefilled syringe(s) and Quantity 1 of 150 mg prefilled syringe(s)" } }, { "extension" : [{ "url" : "dispenseQuantity", "valueQuantity" : { "value" : 5 } }, { "url" : "dispenseUnit", "valueString" : "300mg prefilled syringe(s)" }], "url" : "https://fhir.developer.gene.com/StructureDefinition/dispense-quantity-detail" }, { "extension" : [{ "url" : "dispenseQuantity", "valueQuantity" : { "value" : 2 } }, { "url" : "dispenseUnit", "valueString" : "75mg prefilled syringe(s)" }], "url" : "https://fhir.developer.gene.com/StructureDefinition/dispense-quantity-detail" }, { "extension" : [{ "url" : "dispenseQuantity", "valueQuantity" : { "value" : 1 } }, { "url" : "dispenseUnit", "valueString" : "150 mg prefilled syringe(s)" }], "url" : "https://fhir.developer.gene.com/StructureDefinition/dispense-quantity-detail" }], "numberOfRepeatsAllowed" : 1, "expectedSupplyDuration" : { "value" : 90, "unit" : "d", "system" : "http://unitsofmeasure.org", "code" : "d" } } } }, { "fullUrl" : "urn:uuid:d1654255-0a8d-4f2c-9405-19a6794500a2", "resource" : { "resourceType" : "Organization", "id" : "d1654255-0a8d-4f2c-9405-19a6794500a2", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-organization"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization d1654255-0a8d-4f2c-9405-19a6794500a2

Profile: UAPI Organization

identifier: http://tailormed.co/PAY-200\u00a0(use:\u00a0usual,\u00a0)

type: Insurance Company

name: Dakotacare

telecom: ph: 8778472862(Work)

" }, "identifier" : [{ "use" : "usual", "system" : "http://tailormed.co", "value" : "PAY-200", "assigner" : { "display" : "TailorMed" } }], "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/organization-type", "code" : "ins" }] }], "name" : "Dakotacare", "telecom" : [{ "system" : "phone", "value" : "8778472862", "use" : "work", "rank" : 1 }] } }, { "fullUrl" : "urn:uuid:d1089cdf-7a5f-45b1-99b9-2c021eca5270", "resource" : { "resourceType" : "Organization", "id" : "d1089cdf-7a5f-45b1-99b9-2c021eca5270", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-organization"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization d1089cdf-7a5f-45b1-99b9-2c021eca5270

Profile: UAPI Organization

identifier: http://SOT.com/ab/SOT-001\u00a0(use:\u00a0usual,\u00a0)

type: Site of Treatment

name: FLORIDA HOSPITAL ORLANDO INFUSION CNTR

telecom: ph: 4012704882(Work), fax: 4019974042(Work)

address: 2501 N ORANGE AVE, STE 481 Orlando FL 32804 US

Contacts

-NameTelecom
*Vince Davis (Official)ph: -unknown-
" }, "identifier" : [{ "use" : "usual", "system" : "http://SOT.com/ab", "value" : "SOT-001", "assigner" : { "display" : "Florida Hospital Orlando Infusion Center" } }], "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/organization-type", "code" : "other", "display" : "Site of Treatment" }], "text" : "Site of Treatment" }], "name" : "FLORIDA HOSPITAL ORLANDO INFUSION CNTR", "telecom" : [{ "system" : "phone", "value" : "4012704882", "use" : "work", "rank" : 1 }, { "system" : "fax", "value" : "4019974042", "use" : "work", "rank" : 2 }], "address" : [{ "line" : ["2501 N ORANGE AVE, STE 481"], "city" : "Orlando", "state" : "FL", "postalCode" : "32804", "country" : "US" }], "contact" : [{ "name" : { "use" : "official", "family" : "Davis", "given" : ["Vince"] }, "telecom" : [{ "system" : "phone" }] }] } }] }