Generated Narrative: MessageHeader 9e592049-0434-48f9-8498-d7cf1e80e086 Profile: UAPI MessageHeader event: uapi-event-type enrollment-with-consent: enrollment-with-consent Destinations - Name Endpoint * UAPI-ENR-V2.1 https://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 - Name Endpoint * TailorMed http://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
Generated Narrative: Patient ab45810f-2057-4b15-a24d-be929071cad5 Profile: UAPI Patient Rudy Gandoff (official) Male, DoB: 1965-10-29 ( Patient internal identifier: TM-2345 (use: official, )) Contact Detail ph: 6501231234(Home) ph: 6504561234(Mobile) rudyg@example.com 1234 Airport Blvd South San Francisco CA 94080 US Language: English (preferred) Links: General Practitioner: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500 Managing Organization: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Generated Narrative: Organization 7e45cd4c-8c11-4205-a2b7-fce834bc3511 Profile: UAPI Organization identifier: http://tailormed.co/HCP-01 (use: usual, ) 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)
Generated Narrative: Practitioner 3c5298d3-2b49-4f79-b703-a46623899258 Profile: UAPI Practitioner identifier: National provider identifier/1659533669 (use: official, ) name: RAFAEL FIRSZT (Official)
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 - Type Value Name * Group 12344frgr Group Number order: 1 network: Dakotacare
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
Generated Narrative: QuestionnaireResponse af15ccf2-4e36-400f-8e74-24fbcf29dfbd LinkID Text Definition Answer af15ccf2-4e36-400f-8e74-24fbcf29dfbd Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234 #xD; authorization Authorization # 3333333333 #xD; xolair-prescription-type What is the Prescription Type? Naive/new start #xD; xolair-have-moderate-to-severe-persistent-aa Does the patient have moderate to severe persistent allergic asthma? Yes #xD; xolair-positive-skin-or-rast-test-to-a-perennial-aeroallergen Does the patient have a history of positive skin or RAST test to a perennial aeroallergen? Yes #xD; xolair-have-symptoms-inadequately-controlled-with-ics Does the patient have symptoms inadequately controlled with ICS? Yes #xD; xolair-ige-mediated-fa Does the Patient have a clinical history consistent with IgE-mediated food allergy? No #xD; site-of-treatment Site of Treatment Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500 #xD; contact-patient Do not contact patient Yes #xD; xolair-ige-level-iuml What is the patient's IgE level (IU/mL)? 200 #xD; adot Anticipated Date of Treatment (Optional) 2024-04-30 #xD; dispensing-through Dispensing Through: Specialty Pharmacy #xD; dispense Dispense: Prefilled Syringe #xD; ship-to-2 C&R Ship To Site of Treatment #xD; detailed-message Ok to leave a detailed message? Yes #xD; has-treatment-started Has treatment started? Yes #xD; pos Place of Service Infusion Center #xD; preferred-sp-optional Preferred Specialty Pharmacy (Optional) RX Crossroads #xD; pa-in-place Is prior authorization in place? Yes #xD; prescription-plan Is this a Prescription plan? No #xD; re-verify-benefits-at-pa-expiration Re-verify benefits at PA expiration Yes #xD; xolair-weight-kg Weight (kg) 50 #xD; tcpa-consent TCPA Consent Provided? No #xD; Documentation for this format
Does the patient have moderate to severe persistent allergic asthma?
Does the patient have a history of positive skin or RAST test to a perennial aeroallergen?
Does the patient have symptoms inadequately controlled with ICS?
Does the Patient have a clinical history consistent with IgE-mediated food allergy?
What is the patient's IgE level (IU/mL)?
Anticipated Date of Treatment (Optional)
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
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
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
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 Recorded 2024-04-02 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
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
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
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 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) 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 - Value Unit System Code * 90 d http://unitsofmeasure.org d
Allergic Asthma - 300mg/dose every 2 weeks
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)
Generated Narrative: Organization d1654255-0a8d-4f2c-9405-19a6794500a2 Profile: UAPI Organization identifier: http://tailormed.co/PAY-200 (use: usual, ) type: Insurance Company name: Dakotacare telecom: ph: 8778472862(Work)
Generated Narrative: Organization d1089cdf-7a5f-45b1-99b9-2c021eca5270 Profile: UAPI Organization identifier: http://SOT.com/ab/SOT-001 (use: usual, ) 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 - Name Telecom * Vince Davis (Official) ph: -unknown-
Florida Hospital Orlando Infusion Center