Generated Narrative: MessageHeader 2fa6bc10-aa73-4bec-b357-39839c736ab9 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: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 08:10:13-0500 Sources - Name Endpoint * <MPS Practice Name> http://mps.gene.com focus: Bundle: identifier = Resource identifier: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 08:10:13-0500
Generated Narrative: Patient 746db8d7-8660-4b59-bd2f-fc240bd181b4 Profile: UAPI Patient Ryan Michaelson (official) Male, DoB: 1972-10-29 ( Patient internal identifier: 746db8d7-8660-4b59-bd2f-fc240bd181b4 (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: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 08:10:13-0500 Managing Organization: Bundle: identifier = Resource identifier: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 08:10:13-0500
Generated Narrative: Organization 9edd9044-26ab-4639-b59c-be07d459e045 Profile: UAPI Organization identifier: http://mps.gene.com/sfdcid/0011P000019Y4bLQAS (use: usual, ) type: Healthcare Provider name: Healthstar Physicians telecom: ph: -unknown- address: 420 W MORRIS BLVD MORRISTOWN TN 37813 US contact name: Luis McLean (Official) telecom: ph: 4232002041(Work), fax: 4235862410(Work)
Generated Narrative: Practitioner 0eba1bbc-782a-4727-b186-03e3abe86648 Profile: UAPI Practitioner identifier: http://mps.gene.com/prescriberid/PRES-31448 (use: official, ) name: MARISSA CRUZ (Official)
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: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 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: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 08:10:13-0500 relationship: significant other name: Bob Paul Smith (Official) telecom: ph: 1234567890(Mobile) birthDate: 1972-10-29
Generated Narrative: QuestionnaireResponse 680fa043-5770-4ca9-84e7-5b1acacc1657 LinkID Text Definition Answer 680fa043-5770-4ca9-84e7-5b1acacc1657 Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234 #xD; authorization Authorization # 34567890 #xD; household-size Household size 11 #xD; opn-optional Onsite Pharmacy Name (Optional) Onst Superfarm #xD; preferred-sp-optional Preferred Specialty Pharmacy (Optional) Special Phmcy #xD; site-of-treatment Site of Treatment Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 #xD; contact-patient Do not contact patient No #xD; detailed-message Ok to leave a detailed message? Yes #xD; household-income Annual household income $125,001 - $150,000 #xD; onsite-pharmacy Onsite Pharmacy? Yes #xD; pa-in-place Is prior authorization in place? Yes #xD; pos Place of Service Infusion Center #xD; prescription-plan Is this a Prescription plan? Yes #xD; re-verify-benefits-at-pa-expiration Re-verify benefits at PA expiration Yes #xD; specialty-pharmacy Specialty Pharmacy? Yes #xD; tcpa-consent TCPA Consent Provided? No #xD; text-message Ok to send a text message? Yes #xD; Documentation for this format
Generated Narrative: Condition bc20c5ea-f639-4221-ab61-ce75c5e64aba code: Type 1 diab with mild nonp rtnop with macular edema, r eye subject: Bundle: identifier = Resource identifier: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 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: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 08:10:13-0500 policyRule: HIPAA Authorization
Generated Narrative: Provenance cb626b8a-4e0e-484b-b4fb-1f48fd318418 Profile: UAPI Provenance Provenance for Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 Summary Recorded 2021-01-07 06:49:41+0000 Agents who Bundle: identifier = Resource identifier: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 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: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 08:10:13-0500
Generated Narrative: MedicationRequest 8ae8ca14-1d93-45d1-bfd0-f6dcbc1fede8 Profile: UAPI MedicationRequest status: Active intent: Order medication: Ocrevus subject: Bundle: identifier = Resource identifier: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 08:10:13-0500 requester: Bundle: identifier = Resource identifier: 316b5e76-22a6-499a-a27d-c02d798000c9; type = message; timestamp = 2022-11-11 08:10:13-0500 courseOfTherapyType: Subsequent Dose insurance: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500 note: Every 6 months dosageInstruction text: String (up to 50 characters) DoseAndRates - Dose[x] * 600 mg dispenseRequest numberOfRepeatsAllowed: 1 ExpectedSupplyDurations - Value Unit * 2 300 mg vial(s)
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)
Generated Narrative: Organization 45cf0b29-8c1d-4882-91e1-00bc28c06a52 Profile: UAPI Organization identifier: http://SOT.com/ab/Infusion Site Id (use: usual, ) type: Site of Treatment name: Infusion Centre telecom: ph: 8882704882(Work), fax: 8179974042(Work) address: 8 Ranoldo Terrace Cherry Hill NJ 08034 US Contacts - Name Telecom * Venus Yardav (Official) ph: -unknown-