Generated Narrative: MessageHeader eb5eb40b-78e8-4a52-903a-0348c1eac387 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: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 Sources - Name Endpoint * Vendor_AB http://vendor.com/fhir/enrollmentID/ENR-00001 focus: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: Patient fc2e5a72-c363-4616-ae00-4ad25cbcb45c Profile: UAPI Patient Ryan Michaelson (official) Male, DoB: 1972-10-29 ( Patient internal identifier: 6bcd8467-0473-4836-9128-2e7972f23177 (use: official, )) Contact Detail ph: 1231231234(Home) ph: 1234561234(Mobile) bobster83@example.com 1234 Main St San Francisco CA 94105 US Language: English (preferred) Links: General Practitioner: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 Managing Organization: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: Organization 01c31a2f-321d-4c6e-8349-206af8a88088 Profile: UAPI Organization identifier: http://vendor.com/ab/HOSP-12345 (use: usual, ) type: Healthcare Provider name: Mid Atlantic Retina telecom: mar@example.com address: 8 Ranoldo Terrace Cherry Hill NJ 08034 US contact name: Venus Yardav (Official) telecom: ph: 8882704882(Work), fax: 8179974042(Work)
Generated Narrative: Practitioner 695d0991-5e03-46df-934a-85a28acd95c1 Profile: UAPI Practitioner identifier: Provider number/1922071448 (use: official, ), Tax ID number/00000000 (use: official, ), National provider identifier/1639285034 (use: official, ) name: MARISSA CRUZ (Official)
Centers for Medicare & Medicaid Services
Generated Narrative: Coverage 42b41bdb-1781-49aa-a091-78cdd92129df Profile: UAPI Coverage status: Active type: health insurance plan policy subscriber: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 subscriberId: 4353 beneficiary: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 payor: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 Classes - Type Value Name * Group 12344frgr Group Number order: 1 network: Dakotacare
Generated Narrative: RelatedPerson 4db51d32-65c3-4f8c-959e-0155c6d14545 Profile: UAPI RelatedPerson patient: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 relationship: significant other name: Bob Paul Smith (Official) telecom: ph: 1234567890(Mobile) birthDate: 1972-10-29
Generated Narrative: QuestionnaireResponse 10c743a5-704a-458c-b0da-503472628059 LinkID Text Definition Answer 10c743a5-704a-458c-b0da-503472628059 Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234 #xD; opn-optional Onsite Pharmacy Name (Optional) Name of pharmacy #xD; contact-patient Do not contact patient Yes #xD; prescription-plan Is this a Prescription plan? Yes #xD; place-of-service Place of Service In office #xD; authorization Authorization # #12345 #xD; re-verify-benefits-at-pa-expiration Re-verify benefits at PA expiration Yes #xD; specialty-pharmacy Specialty Pharmacy? Yes #xD; preferred-sp-optional Preferred Specialty Pharmacy (Optional) Accredo #xD; onsite-pharmacy Onsite Pharmacy? Yes #xD; pos Place of Service In Office #xD; pa-in-place Is prior authorization in place? No #xD; detailed-message Ok to leave a detailed message? Yes #xD; herceptin-hylecta-clinical-trial-participant Was the patient a clinical trial participant for this medicine? Yes #xD; herceptin-hylecta-her2-status HER2 status? HER2+ #xD; Documentation for this format
Was the patient a clinical trial participant for this medicine?
Generated Narrative: Condition 446090e1-1888-4f58-a841-ad15be55d330 code: Malignant neoplasm of nipple and areola, right female breast subject: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: Consent 1b53bfb2-1361-4906-acd8-35294d30273b Profile: UAPI Consent status: Active scope: Privacy Consent category: Patient Authorization Signature patient: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 dateTime: 2016-06-16 16:24:45+0000 performer: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 policyRule: HIPAA Authorization Provisions - Type * Opt In
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: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: MedicationRequest 9bbd2c34-8151-4cb8-a11f-d15672c54c35 Profile: UAPI MedicationRequest status: Active intent: Order medication: Herceptin Hylecta subject: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 requester: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 insurance: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Generated Narrative: Organization d3637025-883d-4678-9e0a-1d243a338f9f Profile: UAPI Organization identifier: http://vendor.com/ab/PAY-111 (use: usual, ) type: Insurance Company name: Dakotacare telecom: ph: 8778472862(Work)