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: cc389cd3-9a24-45ed-a40e-d4043dafc881; 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 4ad30d78-8fe3-443d-9971-0706f1887bfa LinkID Text Definition Answer 4ad30d78-8fe3-443d-9971-0706f1887bfa Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234 #xD; authorization Authorization # 4444444666 #xD; dot Date of Treatment 2022-01-02 #xD; opn-optional Onsite Pharmacy Name (Optional) Onsite Pharm #xD; preferred-sp-optional Preferred Specialty Pharmacy (Optional) Pref Spec Pharm #xD; contact-patient Do not contact patient Yes #xD; detailed-message Ok to leave a detailed message? No #xD; has-treatment-started Has treatment started? Yes #xD; line-of-therapy Line of therapy? Third or later #xD; onsite-pharmacy Onsite Pharmacy? Yes #xD; pa-in-place Is prior authorization in place? Yes #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; erivedge-metastatic-disease Metastatic Disease? Yes #xD; erivedge-has-abcc-recurred-following-surgerynot-surgery-not-radiation Has the patient's locally advanced basal cell carcinoma recurred following surgery, or not a candidate for surgery, and not a candidate for radiation? No #xD; certify-patient-for-copay-program Co-pay program Commercial Insurance Yes #xD; erivedge-clinical-trial-participant Was the patient a clinical trial participant for this medicine? Yes #xD; Documentation for this format
Has the patient's locally advanced basal cell carcinoma recurred following surgery, or not a candidate for surgery, and not a candidate for radiation?
Was the patient a clinical trial participant for this medicine?
Generated Narrative: Condition a563b07c-240a-453a-99ab-2c6cd497b0ce code: Basal cell carcinoma of skin of lip 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: Consent 21b30e89-e799-484a-abcd-8c25c0b2599b Profile: UAPI Consent status: Active scope: Privacy Consent category: Prescriber Signature patient: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 policyRule: HIPAA Authorization
Generated Narrative: Provenance 3cb05f30-9842-4651-a17d-930d7170bedf 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 2022-02-07 09:49:39+0000 Agents who Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 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: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: ServiceRequest f71a66c4-f747-4b46-8adc-875a45f8ee7e Profile: UAPI ServiceRequest status: Active intent: Order code: Copay subject: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: MedicationRequest 33dd21ce-4326-4d43-80f5-576f0b6ddfbd Profile: UAPI MedicationRequest status: Active intent: Order medication: Erivedge 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 note: 150 mg Daily dosageInstruction timing: Once per 1 day DoseAndRates - Dose[x] * 150 mg dispenseRequest numberOfRepeatsAllowed: 0 ExpectedSupplyDurations - Value Unit System Code * 3 mo http://unitsofmeasure.org mo
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)