Generated Narrative: MessageHeader b9fc4765-6fc5-4027-8dc1-be9d076c57a2 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: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; 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: 8f7a4f32-ad77-41ab-b70e-5ba56ab86e12; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: List 1b7eeb46-612d-4cbe-8748-e693213879e6 messageContext Mode: Change List Status: Current Items Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 8f7a4f32-ad77-41ab-b70e-5ba56ab86e12; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 4fd42cc9-559c-463e-8968-3e291ba91066; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 4fd42cc9-559c-463e-8968-3e291ba91066; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 4fd42cc9-559c-463e-8968-3e291ba91066; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 8f7a4f32-ad77-41ab-b70e-5ba56ab86e12; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: Patient 1b315218-49b7-4264-816e-05d4b92ecbaa 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: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 Managing Organization: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: Organization e69e5e73-0723-4f42-bfdd-b69f181160bf 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 78ef1b71-b14a-44a1-a1e8-c9c9efcc157c 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 2722d5ae-1658-4d7f-8f64-de1299a1fb7f Profile: UAPI Coverage status: Active type: health insurance plan policy subscriber: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 subscriberId: 4353 beneficiary: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 payor: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; 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 0ec0f18c-5869-4d10-9752-79ea39e1f7ac Profile: UAPI RelatedPerson patient: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; 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 7b28d355-4727-4a69-83f4-a08584e2c024 LinkID Text Definition Answer 7b28d355-4727-4a69-83f4-a08584e2c024 Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234 #xD; detailed-message Ok to leave detailed message Yes #xD; household-size Household size (including you) 2 #xD; household-income-amount Annual household income $75,000 #xD; eligibility-reason Eligibility Reason Insured: No Coverage for Medication #xD; contact-patient Do not contact patient Yes #xD; shipment-options Shipment Options Upfront #xD; ship-to Ship to: Prescriber #xD; prescription-plan Is this a Prescription plan? No #xD; has-treatment-started Has treatment started? No #xD; tcpa-consent TCPA Consent Provided? Yes #xD; ins-type-1 Insurance Type 1 Comm #xD; ins-max-oop-1 Maximum out of pocket 1 5000 #xD; pulmozyme-drug-allergies Drug Allergies No Known #xD; pulmozyme-other-medicines-prescribed Other Medicines Prescribed Placeholder Drug #xD; Documentation for this format
Generated Narrative: Condition 090e5caf-fdbd-4a67-8535-2983a3868f41 code: Cystic fibrosis subject: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: Consent 7ec5069e-799f-413a-a0d2-d107acdfad3d Profile: UAPI Consent status: Active scope: Privacy Consent category: Patient Authorization Signature patient: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 dateTime: 2016-06-16 16:24:45+0000 performer: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 policyRule: HIPAA Authorization Provisions - Type * Opt In
Generated Narrative: Consent 94a59676-0e1f-42d6-b046-3c456758b90b Profile: UAPI Consent status: Active scope: Privacy Consent category: Prescriber Signature patient: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 policyRule: HIPAA Authorization
Generated Narrative: Provenance b83bae44-3e47-4d5c-807e-41944016dc79 Profile: UAPI Provenance Provenance for Bundle: identifier = Resource identifier: 4fd42cc9-559c-463e-8968-3e291ba91066; type = message; timestamp = 2020-03-11 08:10:13-0500 Summary Recorded 2022-02-07 09:49:39+0000 Agents who Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: ServiceRequest 970a569e-aeee-4c84-886d-f26c1e388214 Profile: UAPI ServiceRequest status: Active intent: Order code: Patient Foundation subject: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: MedicationRequest 3285779d-f4b5-4b36-bc36-7807f5ee6c76 Profile: UAPI MedicationRequest status: Active intent: Order medication: Pulmozyme subject: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 requester: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 insurance: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 note: 2.5 mL Inhalation Solution dosageInstruction timing: 2 per 1 day DoseAndRates - Dose[x] * 2.5 ml dispenseRequest numberOfRepeatsAllowed: 1 ExpectedSupplyDurations - Value Unit System Code * 2 mo http://unitsofmeasure.org mo
Generated Narrative: Organization e551b51b-0646-4b23-b1ac-9ec623756ec6 Profile: UAPI Organization identifier: http://vendor.com/ab/PAY-111 (use: usual, ) type: Insurance Company name: Dakotacare telecom: ph: 8778472862(Work)
Generated Narrative: Organization 606bbb19-fe37-4847-b6bb-1cdac172c3ec 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-