https://fhir.developer.gene.com/Bundle/04afa000-48a5-4fb2-8707-6a43af045868
type: Bundle
node role: treeRoot
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-as-enrollment-bundle
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-as-enrollment-bundle
identifier:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: RI
      display:
        v: Resource identifier
  system:
    v: http://tailormed.co
  assigner:
    display:
      v: TailorMed
type:
  v: message
timestamp:
  v: 2024-04-02T08:10:13-05:00

urn:…
type: MessageHeader
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader
text:
  status:
    v: generated
  div: 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
event: Coding
  system:
    v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type
  code:
    v: enrollment-with-consent
destination:
  name:
    v: UAPI-ENR-V2.1
  endpoint:
    v: https://test-us-e1.apis.roche.com/pharma-cmg-ehr-fhir-exp-test/v2/enrollment
sender:
  type:
    v: Organization
source:
  name:
    v: TailorMed
  endpoint:
    v: http://tailormed.co/fhir/enrollmentID/ENR-00001
focus:
  type:
    v: List

urn:…
type: List
text:
  status:
    v: 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 =…
status:
  v: current
mode:
  v: changes
title:
  v: messageContext
entry:
  item:
    type:
      v: Patient
entry:
  item:
    type:
      v: Organization
entry:
  item:
    type:
      v: Practitioner
entry:
  item:
    type:
      v: Coverage
entry:
  item:
    type:
      v: RelatedPerson
entry:
  item:
    type:
      v: QuestionnaireResponse
entry:
  item:
    type:
      v: Condition
entry:
  item:
    type:
      v: Consent
entry:
  item:
    type:
      v: Consent
entry:
  item:
    type:
      v: Provenance
entry:
  item:
    type:
      v: ServiceRequest
entry:
  item:
    type:
      v: ServiceRequest
entry:
  item:
    type:
      v: MedicationRequest
entry:
  item:
    type:
      v: Organization
entry:
  item:
    type:
      v: Organization

urn:…
type: Patient
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-patient
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-patient
text:
  status:
    v: 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 (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
identifier:
  use:
    v: official
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: PI
      display:
        v: Patient internal identifier
  system:
    v: http://tailormed.co
  value:
    v: TM-2345
  assigner:
    display:
      v: TailorMed
name:
  use:
    v: official
  family:
    v: Gandoff
  given:
    v: Rudy
telecom:
  system:
    v: phone
  value:
    v: 6501231234
  use:
    v: home
  rank:
    v: 1
telecom:
  system:
    v: phone
  value:
    v: 6504561234
  use:
    v: mobile
  rank:
    v: 2
telecom:
  system:
    v: email
  use:
    v: home
  rank:
    v: 3
gender:
  v: male
birth date:
  v: 1965-10-29
address:
  line:
    v: 1234 Airport Blvd
  city:
    v: South San Francisco
  state:
    v: CA
  postal code:
    v: 94080
  country:
    v: US
communication:
  language:
    coding:
      system:
        v: urn:ietf:bcp:47
      code:
        v: en
      display:
        v: English
  preferred:
    v: true

urn:…
type: Organization
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
text:
  status:
    v: generated
  div: 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)
identifier:
  use:
    v: usual
  system:
    v: http://tailormed.co
  value:
    v: HCP-01
  assigner:
    display:
      v: TailorMed
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/organization-type
    code:
      v: prov
    display:
      v: Healthcare Provider
name:
  v: TANNER CLINIC MURRAY
telecom:
  system:
    v: email
address:
  line:
    v: 5296 S COMMERCE DR
  city:
    v: Murray
  state:
    v: UT
  postal code:
    v: 84107
  country:
    v: US
contact:
  name:
    use:
      v: official
    family:
      v: Yardav
    given:
      v: Venus
  telecom:
    system:
      v: phone
    value:
      v: 8882704882
    use:
      v: work
    rank:
      v: 1
  telecom:
    system:
      v: fax
    value:
      v: 8179974042
    use:
      v: work
    rank:
      v: 2

urn:…
type: Practitioner
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner
text:
  status:
    v: generated
  div: Generated Narrative: Practitioner 3c5298d3-2b49-4f79-b703-a46623899258 Profile: UAPI Practitioner identifier: National provider identifier/1659533669 (use: official, ) name: RAFAEL FIRSZT (Official)
identifier:
  use:
    v: official
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: NPI
      display:
        v: National provider identifier
  system:
    v: http://hl7.org/fhir/sid/us-npi
  value:
    v: 1659533669
name:
  use:
    v: official
  family:
    v: FIRSZT
  given:
    v: RAFAEL

urn:…
type: Coverage
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-coverage
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-coverage
text:
  status:
    v: 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 - Type Value Name * Group 12344frgr Group Number order: 1 network: Dakotacare
status:
  v: active
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-ActCode
    code:
      v: HIP
    display:
      v: health insurance plan policy
subscriber:
  type:
    v: RelatedPerson
subscriber id:
  v: 4353
beneficiary:
  type:
    v: Patient
payor:
  type:
    v: Organization
class:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/coverage-class
      code:
        v: group
      display:
        v: Group
  value:
    v: 12344frgr
  name:
    v: Group Number
order:
  v: 1
network:
  v: Dakotacare

urn:…
type: RelatedPerson
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson
text:
  status:
    v: 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:
  type:
    v: Patient
relationship:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-RoleCode
    code:
      v: SIGOTHR
    display:
      v: significant other
name:
  use:
    v: official
  family:
    v: Gandoff
  given:
    v: Rebecca
telecom:
  system:
    v: phone
  value:
    v: 6504567890
  use:
    v: mobile
birth date:
  v: 1972-10-29

urn:…
type: QuestionnaireResponse
text:
  status:
    v: generated
  div: Generated Narrative: QuestionnaireResponse af15ccf2-4e36-400f-8e74-24fbcf29dfbd LinkID Text Definition Answer<img src="[binary]" alt="doco" style="background-color: inherit"/> 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; <img src="[binary]" alt="doco" style="backgroun…
questionnaire:
  v: https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234
  link: https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234
status:
  v: completed
subject:
  type:
    v: Patient
item:
  link id:
    v: authorization
  text:
    v: Authorization #
  answer:
    value: string
      v: 3333333333
item:
  link id:
    v: xolair-prescription-type
  text:
    v: What is the Prescription Type?
  answer:
    value: string
      v: Naive/new start
item:
  link id:
    v: xolair-have-moderate-to-severe-persistent-aa
  text:
    v: Does the patient have moderate to severe persistent allergic asthma?
  answer:
    value: string
      v: Yes
item:
  link id:
    v: xolair-positive-skin-or-rast-test-to-a-perennial-aeroallergen
  text:
    v: Does the patient have a history of positive skin or RAST test to a perennial aeroallergen?
  answer:
    value: string
      v: Yes
item:
  link id:
    v: xolair-have-symptoms-inadequately-controlled-with-ics
  text:
    v: Does the patient have symptoms inadequately controlled with ICS?
  answer:
    value: string
      v: Yes
item:
  link id:
    v: xolair-ige-mediated-fa
  text:
    v: Does the Patient have a clinical history consistent with IgE-mediated food allergy?
  answer:
    value: string
      v: No
item:
  link id:
    v: site-of-treatment
  text:
    v: Site of Treatment
  answer:
    value: Reference
      type:
        v: Organization
item:
  link id:
    v: contact-patient
  text:
    v: Do not contact patient
  answer:
    value: string
      v: Yes
item:
  link id:
    v: xolair-ige-level-iuml
  text:
    v: What is the patient's IgE level (IU/mL)?
  answer:
    value: decimal
      v: 200
item:
  link id:
    v: adot
  text:
    v: Anticipated Date of Treatment (Optional)
  answer:
    value: date
      v: 2024-04-30
item:
  link id:
    v: dispensing-through
  text:
    v: Dispensing Through:
  answer:
    value: string
      v: Specialty Pharmacy
item:
  link id:
    v: dispense
  text:
    v: Dispense:
  answer:
    value: string
      v: Prefilled Syringe
item:
  link id:
    v: ship-to-2
  text:
    v: C&R Ship To
  answer:
    value: string
      v: Site of Treatment
item:
  link id:
    v: detailed-message
  text:
    v: Ok to leave a detailed message?
  answer:
    value: string
      v: Yes
item:
  link id:
    v: has-treatment-started
  text:
    v: Has treatment started?
  answer:
    value: string
      v: Yes
item:
  link id:
    v: pos
  text:
    v: Place of Service
  answer:
    value: string
      v: Infusion Center
item:
  link id:
    v: preferred-sp-optional
  text:
    v: Preferred Specialty Pharmacy (Optional)
  answer:
    value: string
      v: RX Crossroads
item:
  link id:
    v: pa-in-place
  text:
    v: Is prior authorization in place?
  answer:
    value: string
      v: Yes
item:
  link id:
    v: prescription-plan
  text:
    v: Is this a Prescription plan?
  answer:
    value: string
      v: No
item:
  link id:
    v: re-verify-benefits-at-pa-expiration
  text:
    v: Re-verify benefits at PA expiration
  answer:
    value: string
      v: Yes
item:
  link id:
    v: xolair-weight-kg
  text:
    v: Weight (kg)
  answer:
    value: decimal
      v: 50
item:
  link id:
    v: tcpa-consent
  text:
    v: TCPA Consent Provided?
  answer:
    value: string
      v: No

urn:…
type: Condition
text:
  status:
    v: 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:
      v: http://hl7.org/fhir/sid/icd-10-cm
    code:
      v: J45.50
subject:
  type:
    v: Patient

urn:…
type: Consent
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-consent
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-consent
text:
  status:
    v: 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:
  v: active
scope:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/consentscope
    code:
      v: patient-privacy
    display:
      v: Privacy Consent
category:
  coding: https://loinc.org/rdf/59284-0
    system:
      v: http://loinc.org
    code:
      v: 59284-0
    display:
      v: Patient Authorization Signature
patient:
  type:
    v: Patient
date time:
  v: 2024-04-02T16:24:45Z
performer:
  type:
    v: Patient
policy rule:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/consentpolicycodes
    code:
      v: hipaa-auth
    display:
      v: HIPAA Authorization
provision:
  type:
    v: permit

urn:…
type: Consent
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-consent
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-consent
text:
  status:
    v: 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:
  v: active
scope:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/consentscope
    code:
      v: patient-privacy
    display:
      v: Privacy Consent
category:
  coding: https://loinc.org/rdf/59284-0
    system:
      v: http://loinc.org
    code:
      v: 59284-0
    display:
      v: Prescriber Signature
patient:
  type:
    v: Patient
date time:
  v: 2024-04-02T16:24:45Z
performer:
  type:
    v: Patient
policy rule:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/consentpolicycodes
    code:
      v: hipaa-auth
    display:
      v: HIPAA Authorization
provision:
  type:
    v: permit

urn:…
type: Provenance
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-provenance
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-provenance
text:
  status:
    v: 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 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
target:
  type:
    v: Consent
recorded:
  v: 2024-04-02T09:49:39.382941+00:00
agent:
  who:
    type:
      v: Practitioner
signature:
  type:
    system:
      v: urn:iso-astm:E1762-95:2013
    code:
      v: 1.2.840.10065.1.12.1.7
    display:
      v: Consent Signature
  when:
    v: 2024-04-02T09:49:39.382897+00:00
  who:
    type:
      v: Practitioner
  sig format:
    v: image/*

urn:…
type: ServiceRequest
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-servicerequest
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-servicerequest
text:
  status:
    v: 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:
  v: active
intent:
  v: order
code:
  coding:
    system:
      v: https://fhir.developer.gene.com/CodeSystem/uapi-sr-type
    code:
      v: bipa
subject:
  type:
    v: Patient

urn:…
type: ServiceRequest
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-servicerequest
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-servicerequest
text:
  status:
    v: 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:
  v: active
intent:
  v: order
code:
  coding:
    system:
      v: https://fhir.developer.gene.com/CodeSystem/uapi-sr-type
    code:
      v: starter
subject:
  type:
    v: Patient

urn:…
type: MedicationRequest
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-medicationrequest
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-medicationrequest
text:
  status:
    v: 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 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
status:
  v: active
intent:
  v: order
medication: CodeableConcept
  coding:
    system:
      v: https://fhir.developer.gene.com/CodeSystem/uapi-product-name
    code:
      v: xolair
    display:
      v: Xolair
subject:
  type:
    v: Patient
requester:
  type:
    v: Practitioner
course of therapy type:
  text:
    v: Starter (Pre filled Syringe)
insurance:
  type:
    v: Coverage
note:
  text:
    v: Allergic Asthma - 300mg/dose every 2 weeks
dosage instruction:
  timing:
    repeat:
      frequency:
        v: 1
      period:
        v: 2
      period unit:
        v: wk
  dose and rate:
    dose: Quantity
      value:
        v: 300
      unit:
        v: mg
dispense request:
  extension:
    url:
      v: https://fhir.developer.gene.com/StructureDefinition/dispenser-instruction
    value: Annotation
      text:
        v: 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:
    extension:
      url:
        v: dispenseQuantity
      value: Quantity
    extension:
      url:
        v: dispenseUnit
      value: string
        v: 300mg prefilled syringe(s)
    url:
      v: https://fhir.developer.gene.com/StructureDefinition/dispense-quantity-detail
  extension:
    extension:
      url:
        v: dispenseQuantity
      value: Quantity
    extension:
      url:
        v: dispenseUnit
      value: string
        v: 75mg prefilled syringe(s)
    url:
      v: https://fhir.developer.gene.com/StructureDefinition/dispense-quantity-detail
  extension:
    extension:
      url:
        v: dispenseQuantity
      value: Quantity
    extension:
      url:
        v: dispenseUnit
      value: string
        v: 150 mg prefilled syringe(s)
    url:
      v: https://fhir.developer.gene.com/StructureDefinition/dispense-quantity-detail
  number of repeats allowed:
    v: 1
  expected supply duration:
    value:
      v: 90
    unit:
      v: d
    system:
      v: http://unitsofmeasure.org
    code:
      v: d

urn:…
type: Organization
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
text:
  status:
    v: generated
  div: 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)
identifier:
  use:
    v: usual
  system:
    v: http://tailormed.co
  value:
    v: PAY-200
  assigner:
    display:
      v: TailorMed
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/organization-type
    code:
      v: ins
name:
  v: Dakotacare
telecom:
  system:
    v: phone
  value:
    v: 8778472862
  use:
    v: work
  rank:
    v: 1

urn:…
type: Organization
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
text:
  status:
    v: generated
  div: 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-
identifier:
  use:
    v: usual
  system:
    v: http://SOT.com/ab
  value:
    v: SOT-001
  assigner:
    display:
      v: Florida Hospital Orlando Infusion Center
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/organization-type
    code:
      v: other
    display:
      v: Site of Treatment
  text:
    v: Site of Treatment
name:
  v: FLORIDA HOSPITAL ORLANDO INFUSION CNTR
telecom:
  system:
    v: phone
  value:
    v: 4012704882
  use:
    v: work
  rank:
    v: 1
telecom:
  system:
    v: fax
  value:
    v: 4019974042
  use:
    v: work
  rank:
    v: 2
address:
  line:
    v: 2501 N ORANGE AVE, STE 481
  city:
    v: Orlando
  state:
    v: FL
  postal code:
    v: 32804
  country:
    v: US
contact:
  name:
    use:
      v: official
    family:
      v: Davis
    given:
      v: Vince
  telecom:
    system:
      v: phone

v: 5

v: 2

v: 1