Generated Narrative: MessageHeader dfc8272e-a729-4d86-9bc0-fdddee41edf9 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: 316e9740-2c4d-4c5d-98b0-c68c84706898; 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 d7bed1e1-e7a2-41da-ab5e-75ce76db3e07 LinkID Text Definition Answer d7bed1e1-e7a2-41da-ab5e-75ce76db3e07 Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234 #xD; contact-patient Do not contact patient No #xD; prescription-plan Is this a Prescription Plan? No #xD; detailed-message Ok to leave a detailed message? No #xD; evrysdi-date-measured Date measured 2024-12-30 #xD; evrysdi-route Route Feeding Tube #xD; evrysdi-ftt Feeding tube type Gastrostomy #xD; evrysdi-sma-type SMA type 1 #xD; evrysdi-pw Patient Weight 90 #xD; evrysdi-weight-unit Weight unit lbs #xD; evrysdi-taken-evrysdi Has patient taken Evrysdi? Yes #xD; evrysdi-drug-non-drug-allergies Drug and non-drug allergies Yes #xD; evrysdi-allergies Allergies Milk #xD; evrysdi-previous-sma-therapy Previous SMA therapy Spinraza (nusinersen) #xD; evrysdi-smn2-copy-number SMN2 copy number 26 #xD; evrysdi-spinraza-last-dose Spinraza® last dose 2024-12-30 #xD; evrysdi-expected-evrysdi-treatment-start-date Expected Evrysdi treatment start date 2025-01-30 #xD; tcpa-consent TCPA Consent Provided? Yes #xD; Documentation for this format
Generated Narrative: Condition 090e5caf-fdbd-4a67-8535-2983a3868f41 code: Infantile spinal muscular atrophy, type I [Werdnig-Hoffman] subject: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500
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: 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: 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 3f640e58-2f13-4d07-9356-8bc2ee64054d Profile: UAPI ServiceRequest status: Active intent: Order code: Benefit Investigation / Prior Authorization subject: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500
Generated Narrative: MedicationRequest 36d3ee2a-630e-4109-9182-cf3d3b7fbbb7 Profile: UAPI MedicationRequest status: Active intent: Order medication: Evrysdi 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 courseOfTherapyType: Oral Solution - 0.75mg/mL 80mL insurance: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500 note: 5 mg once daily dosageInstruction timing: Once per 1 day DoseAndRates - Dose[x] * 5 mg dispenseRequest UAPI MedicationRequest Dispenser Instructions: Dispense Instruction: 5mg and 6.6mL daily UAPI MedicationRequest Dispense Quantity Detailed Breakdown dispenseQuantity: 5 dispenseUnit: mg UAPI MedicationRequest Dispense Quantity Detailed Breakdown dispenseQuantity: 6.6 dispenseUnit: mL numberOfRepeatsAllowed: 12 ExpectedSupplyDurations - Value Unit System Code * 29 mo http://unitsofmeasure.org mo
Dispense Instruction: 5mg and 6.6mL daily
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)