{ "resourceType" : "Bundle", "id" : "digital-consent-only", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-as-enrollment-bundle"] }, "identifier" : { "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "RI", "display" : "Resource identifier" }] }, "system" : "http://vendor.com/ab", "value" : "316e9740-2c4d-4c5d-98b0-c68c84706807", "assigner" : { "display" : "Alpha Beta" } }, "type" : "message", "timestamp" : "2020-03-11T08:10:13-05:00", "entry" : [{ "fullUrl" : "urn:uuid:eb5eb40b-78e8-4a52-903a-0348c1eac387", "resource" : { "resourceType" : "MessageHeader", "id" : "fe0cc042-1a9a-4bfc-9989-aba6152336dco", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: MessageHeader fe0cc042-1a9a-4bfc-9989-aba6152336dco

Profile: UAPI MessageHeader

event: uapi-event-type consent-only: consent-only

Destinations

-NameEndpoint
*UAPI-ENR-V2.1https://test-us-e1.apis.roche.com/pharma-cmg-ehr-fhir-exp-test/v2/patient_consent

sender: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500

Sources

-NameEndpoint
*Vendor_ABhttp://vendor.com/fhir/enrollmentID/ENR-00001

focus: Bundle: identifier = Resource identifier: 316e9740-2c4d-4c5d-98b0-c68c84706807; type = message; timestamp = 2020-03-11 08:10:13-0500

" }, "eventCoding" : { "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type", "code" : "consent-only" }, "destination" : [{ "name" : "UAPI-ENR-V2.1", "endpoint" : "https://test-us-e1.apis.roche.com/pharma-cmg-ehr-fhir-exp-test/v2/patient_consent" }], "sender" : { "reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088", "type" : "Organization" }, "source" : { "name" : "Vendor_AB", "endpoint" : "http://vendor.com/fhir/enrollmentID/ENR-00001" }, "focus" : [{ "reference" : "urn:uuid:b0a24993-d80b-4c68-8239-fcefd05883b9", "type" : "List" }] } }, { "fullUrl" : "urn:uuid:b0a24993-d80b-4c68-8239-fcefd05883b9", "resource" : { "resourceType" : "List", "id" : "b0a24993-d80b-4c68-8239-fcefd05883b9", "text" : { "status" : "generated", "div" : "

Generated Narrative: List b0a24993-d80b-4c68-8239-fcefd05883b9

messageContext

Mode: Change List Status: Current
Items
Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Bundle: identifier = Resource identifier: 316e9740-2c4d-4c5d-98b0-c68c84706807; type = message; timestamp = 2020-03-11 08:10:13-0500
Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
" }, "status" : "current", "mode" : "changes", "title" : "messageContext", "entry" : [{ "item" : { "reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c", "type" : "Patient" } }, { "item" : { "reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088", "type" : "Organization" } }, { "item" : { "reference" : "urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1", "type" : "Practitioner" } }, { "item" : { "reference" : "urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545", "type" : "RelatedPerson" } }, { "item" : { "reference" : "urn:uuid:df922ef2-f4b8-4088-8276-f5ae1b019374", "type" : "QuestionnaireResponse" } }, { "item" : { "reference" : "urn:uuid:1b53bfb2-1361-4906-acd8-35294d30273b", "type" : "Consent" } }] } }, { "fullUrl" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c", "resource" : { "resourceType" : "Patient", "id" : "fc2e5a72-c363-4616-ae00-4ad25cbcb45c", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-patient"] }, "text" : { "status" : "generated", "div" : "

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\u00a0(use:\u00a0official,\u00a0))

Contact Detail
Language:English (preferred)
Links:
" }, "identifier" : [{ "use" : "official", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "PI", "display" : "Patient internal identifier" }] }, "system" : "http://vendor.com/ab", "value" : "6bcd8467-0473-4836-9128-2e7972f23177", "assigner" : { "display" : "AB Vendor" } }], "name" : [{ "use" : "official", "family" : "Michaelson", "given" : ["Ryan"] }], "telecom" : [{ "system" : "phone", "value" : "1231231234", "use" : "home", "rank" : 1 }, { "system" : "phone", "value" : "1234561234", "use" : "mobile", "rank" : 2 }, { "system" : "email", "value" : "bobster83@example.com", "use" : "home", "rank" : 3 }], "gender" : "male", "birthDate" : "1972-10-29", "address" : [{ "line" : ["1234 Main St"], "city" : "San Francisco", "state" : "CA", "postalCode" : "94105", "country" : "US" }], "communication" : [{ "language" : { "coding" : [{ "system" : "urn:ietf:bcp:47", "code" : "en", "display" : "English" }] }, "preferred" : true }], "generalPractitioner" : [{ "reference" : "urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1" }], "managingOrganization" : { "reference" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088" } } }, { "fullUrl" : "urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088", "resource" : { "resourceType" : "Organization", "id" : "01c31a2f-321d-4c6e-8349-206af8a88088", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-organization"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization 01c31a2f-321d-4c6e-8349-206af8a88088

Profile: UAPI Organization

identifier: http://vendor.com/ab/HOSP-12345\u00a0(use:\u00a0usual,\u00a0)

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)

" }, "identifier" : [{ "use" : "usual", "system" : "http://vendor.com/ab", "value" : "HOSP-12345", "assigner" : { "display" : "AB Vendor" } }], "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/organization-type", "code" : "prov", "display" : "Healthcare Provider" }] }], "name" : "Mid Atlantic Retina", "telecom" : [{ "system" : "email", "value" : "mar@example.com" }], "address" : [{ "line" : ["8 Ranoldo Terrace"], "city" : "Cherry Hill", "state" : "NJ", "postalCode" : "08034", "country" : "US" }], "contact" : [{ "name" : { "use" : "official", "family" : "Yardav", "given" : ["Venus"] }, "telecom" : [{ "system" : "phone", "value" : "8882704882", "use" : "work", "rank" : 1 }, { "system" : "fax", "value" : "8179974042", "use" : "work", "rank" : 2 }] }] } }, { "fullUrl" : "urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1", "resource" : { "resourceType" : "Practitioner", "id" : "695d0991-5e03-46df-934a-85a28acd95c1", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Practitioner 695d0991-5e03-46df-934a-85a28acd95c1

Profile: UAPI Practitioner

identifier: Provider number/1922071448\u00a0(use:\u00a0official,\u00a0), Tax ID number/00000000\u00a0(use:\u00a0official,\u00a0), National provider identifier/1639285034\u00a0(use:\u00a0official,\u00a0)

name: MARISSA CRUZ (Official)

" }, "identifier" : [{ "use" : "official", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "PRN", "display" : "Provider number" }] }, "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "1922071448", "assigner" : { "display" : "Centers for Medicare & Medicaid Services" } }, { "use" : "official", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "TAX", "display" : "Tax ID number" }] }, "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "00000000" }, { "use" : "official", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "NPI", "display" : "National provider identifier" }] }, "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "1639285034" }], "name" : [{ "use" : "official", "family" : "CRUZ", "given" : ["MARISSA"] }] } }, { "fullUrl" : "urn:uuid:4db51d32-65c3-4f8c-959e-0155c6d14545", "resource" : { "resourceType" : "RelatedPerson", "id" : "4db51d32-65c3-4f8c-959e-0155c6d14545", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson"] }, "text" : { "status" : "generated", "div" : "

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

" }, "patient" : { "reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c", "type" : "Patient" }, "relationship" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "code" : "SIGOTHR", "display" : "significant other" }] }], "name" : [{ "use" : "official", "family" : "Smith", "given" : ["Bob Paul"] }], "telecom" : [{ "system" : "phone", "value" : "1234567890", "use" : "mobile" }], "birthDate" : "1972-10-29" } }, { "fullUrl" : "urn:uuid:df922ef2-f4b8-4088-8276-f5ae1b019374", "resource" : { "resourceType" : "QuestionnaireResponse", "id" : "df922ef2-f4b8-4088-8276-f5ae1b019374", "text" : { "status" : "generated", "div" : "

Generated Narrative: QuestionnaireResponse df922ef2-f4b8-4088-8276-f5ae1b019374

\r\n\r\n\r\n\r\n\r\n
LinkIDTextDefinitionAnswer\"doco\"
\".\"\".\" df922ef2-f4b8-4088-8276-f5ae1b019374Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234
\".\"\".\"\".\" detailed-messageOk to leave a detailed message?Yes
\".\"\".\"\".\" household-sizeHousehold size (including you)3
\".\"\".\"\".\" household-income-amountAnnual household income amount$75,000
\".\"\".\"\".\" tcpa-consentTCPA Consent Provided?Yes

\"doco\" Documentation for this format
" }, "questionnaire" : "https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234", "status" : "completed", "subject" : { "reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c", "type" : "Patient" }, "item" : [{ "linkId" : "detailed-message", "text" : "Ok to leave a detailed message?", "answer" : [{ "valueString" : "Yes" }] }, { "linkId" : "household-size", "text" : "Household size (including you)", "answer" : [{ "valueString" : "3" }] }, { "linkId" : "household-income-amount", "text" : "Annual household income amount", "answer" : [{ "valueString" : "$75,000" }] }, { "linkId" : "tcpa-consent", "text" : "TCPA Consent Provided?", "answer" : [{ "valueString" : "Yes" }] }] } }, { "fullUrl" : "urn:uuid:1b53bfb2-1361-4906-acd8-35294d30273b", "resource" : { "resourceType" : "Consent", "id" : "1b53bfb2-1361-4906-acd8-35294d30273b", "meta" : { "profile" : ["https://fhir.developer.gene.com/StructureDefinition/uapi-consent"] }, "text" : { "status" : "generated", "div" : "

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
" }, "status" : "active", "scope" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/consentscope", "code" : "patient-privacy", "display" : "Privacy Consent" }] }, "category" : [{ "coding" : [{ "system" : "http://loinc.org", "code" : "59284-0", "display" : "Patient Authorization Signature" }] }], "patient" : { "reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c", "type" : "Patient" }, "dateTime" : "2016-06-16T16:24:45Z", "performer" : [{ "reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c", "type" : "Patient" }], "policyRule" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/consentpolicycodes", "code" : "hipaa-auth", "display" : "HIPAA Authorization" }] }, "provision" : { "type" : "permit" } } }] }