uapi-copay-bundle-copay-pact-6
type: Bundle
node role: treeRoot
id:
  v: uapi-copay-bundle-copay-pact-6
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-copay-enrollment-bundle
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-copay-enrollment-bundle
identifier:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: RI
      display:
        v: Resource identifier
  system:
    v: http://gene.com/pact
  assigner:
    display:
      v: Genentech PACT
type:
  v: message
timestamp:
  v: 2025-09-25T06:10:13-05:00

urn:…
type: MessageHeader
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader
text:
  status:
    v: generated
  div: Generated Narrative: MessageHeader d6c3f2ea-5ded-4167-b4a1-5dae67c49c57 Profile: UAPI MessageHeader event: uapi-event-type copay-enrollment: copay-enrollment Destinations - Name Endpoint * UAPI-ENR-V2.0 https://test-us-e1.apis.roche.com/pharma-cmg-ehr-fhir-exp-test/v2/enrollment sender: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Sources - Name Endpoint * Vendor_EZScript http://ezscript.com focus: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500
event: Coding
  system:
    v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type
  code:
    v: copay-enrollment
destination:
  name:
    v: UAPI-ENR-V2.0
  endpoint:
    v: https://test-us-e1.apis.roche.com/pharma-cmg-ehr-fhir-exp-test/v2/enrollment
sender:
  type:
    v: Organization
source:
  name:
    v: Vendor_EZScript
  endpoint:
    v: http://ezscript.com
focus:
  type:
    v: List

urn:…
type: List
text:
  status:
    v: generated
  div: Generated Narrative: List f7feff60-0f93-4d09-8d47-ad2da5daad09 messageContext Mode: Change List Status: Current Items Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500
status:
  v: current
mode:
  v: changes
title:
  v: messageContext
entry:
  item:
    type:
      v: Patient
entry:
  item:
    type:
      v: Organization
entry:
  item:
    type:
      v: Organization
entry:
  item:
    type:
      v: Organization
entry:
  item:
    type:
      v: Practitioner
entry:
  item:
    type:
      v: RelatedPerson
entry:
  item:
    type:
      v: QuestionnaireResponse
entry:
  item:
    type:
      v: Consent
entry:
  item:
    type:
      v: Coverage
entry:
  item:
    type:
      v: Coverage
entry:
  item:
    type:
      v: Task

urn:…
type: Patient
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-patient
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-patient
text:
  status:
    v: generated
  div: Generated Narrative: Patient a5afba98-1ed4-4e91-a69f-856042af8744 Profile: UAPI Patient Kraig Tannebaum (official) Male, DoB: 1989-05-23 ( Patient internal identifier: TMPAT-9029 (use: usual, )) Contact Detail ph: 9283961277(Home) kraigt@example.com 543 Glass Drive Greensburg PA 15601 US Language: English (preferred) Links: General Practitioner: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 Managing Organization: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500
identifier:
  use:
    v: usual
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: PI
      display:
        v: Patient internal identifier
  system:
    v: http://ezscript.com
  value:
    v: TMPAT-9029
  assigner:
    display:
      v: EZScript
name:
  use:
    v: official
  family:
    v: Tannebaum
  given:
    v: Kraig
telecom:
  system:
    v: phone
  value:
    v: 9283961277
  use:
    v: home
  rank:
    v: 1
telecom:
  system:
    v: email
  use:
    v: home
  rank:
    v: 2
gender:
  v: male
birth date:
  v: 1989-05-23
address:
  line:
    v: 543 Glass Drive
  city:
    v: Greensburg
  state:
    v: PA
  postal code:
    v: 15601
  country:
    v: US
communication:
  language:
    coding:
      system:
        v: urn:ietf:bcp:47
      code:
        v: en
      display:
        v: English
  preferred:
    v: true

urn:…
type: Organization
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
text:
  status:
    v: generated
  div: Generated Narrative: Organization 1c32dbdb-7cef-40b0-b6b3-37b89adaa709 Profile: UAPI Organization identifier: http://ezscript.com/CC-1111 (use: usual, ) type: Healthcare Provider name: Cleveland Clinic telecom: ph: 8882704882(Work)
identifier:
  use:
    v: usual
  system:
    v: http://ezscript.com
  value:
    v: CC-1111
  assigner:
    display:
      v: EZScript
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/organization-type
    code:
      v: prov
    display:
      v: Healthcare Provider
name:
  v: Cleveland Clinic
telecom:
  system:
    v: phone
  value:
    v: 8882704882
  use:
    v: work
  rank:
    v: 1

urn:…
type: Organization
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
text:
  status:
    v: generated
  div: Generated Narrative: Organization ee81a811-b11f-4757-ae8a-26a90f54b0f1 Profile: UAPI Organization identifier: http://ezscript.com/PAY-395 (use: usual, ) type: Insurance Company name: AETNA telecom: ph: 8778472862(Work)
identifier:
  use:
    v: usual
  system:
    v: http://ezscript.com
  value:
    v: PAY-395
  assigner:
    display:
      v: EZScript
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/organization-type
    code:
      v: ins
name:
  v: AETNA
telecom:
  system:
    v: phone
  value:
    v: 8778472862
  use:
    v: work
  rank:
    v: 1

urn:…
type: Organization
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-organization
text:
  status:
    v: generated
  div: Generated Narrative: Organization de4a57e8-f09c-45c5-a97e-5f5aecebbf10 Profile: UAPI Organization identifier: http://ezscript.com/PAY-444 (use: usual, ) type: Insurance Company name: CVS telecom: ph: 8778479999(Work)
identifier:
  use:
    v: usual
  system:
    v: http://ezscript.com
  value:
    v: PAY-444
  assigner:
    display:
      v: EZScript
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/organization-type
    code:
      v: ins
name:
  v: CVS
telecom:
  system:
    v: phone
  value:
    v: 8778479999
  use:
    v: work
  rank:
    v: 2

urn:…
type: Practitioner
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner
text:
  status:
    v: generated
  div: Generated Narrative: Practitioner a2e5812b-2243-4ca1-a50a-3eccf3052a0a Profile: UAPI Practitioner identifier: Provider identifier/1922071448 (use: official, ), National provider identifier/1639285034 (use: official, ) name: MARISSA CRUZ (Official) telecom: ph: 8882704882(Work) address: 8 Ranoldo Terrace Cherry Hill NJ 08034 US
identifier:
  use:
    v: official
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: PRN
      display:
        v: Provider identifier
  system:
    v: http://hl7.org/fhir/sid/us-npi
  value:
    v: 1922071448
  assigner:
    display:
      v: Cleveland Clinic
identifier:
  use:
    v: official
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: NPI
      display:
        v: National provider identifier
  system:
    v: http://hl7.org/fhir/sid/us-npi
  value:
    v: 1639285034
name:
  use:
    v: official
  family:
    v: CRUZ
  given:
    v: MARISSA
telecom:
  system:
    v: phone
  value:
    v: 8882704882
  use:
    v: work
  rank:
    v: 1
address:
  line:
    v: 8 Ranoldo Terrace
  city:
    v: Cherry Hill
  state:
    v: NJ
  postal code:
    v: 08034
  country:
    v: US

urn:…
type: RelatedPerson
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson
text:
  status:
    v: generated
  div: Generated Narrative: RelatedPerson 680f3d4e-6316-4d51-a566-9710ea37e12c Profile: UAPI RelatedPerson patient: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 relationship: spouse name: Janice Tannebaum (Official) telecom: ph: 8723961277(Mobile) address: 543 Glass Drive Greensburg PA 15601 US
patient:
  type:
    v: Patient
relationship:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-RoleCode
    code:
      v: sps
    display:
      v: spouse
name:
  use:
    v: official
  family:
    v: Tannebaum
  given:
    v: Janice
telecom:
  system:
    v: phone
  value:
    v: 8723961277
  use:
    v: mobile
address:
  line:
    v: 543 Glass Drive
  city:
    v: Greensburg
  state:
    v: PA
  postal code:
    v: 15601
  country:
    v: US

urn:…
type: QuestionnaireResponse
text:
  status:
    v: generated
  div: Generated Narrative: QuestionnaireResponse 17e56128-e84e-4732-b228-b3b45346b39f LinkID Text Definition Answer<img src="[binary]" alt="doco" style="background-color: inherit"/> 17e56128-e84e-4732-b228-b3b45346b39f Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234 #xD; consent-to-enroll Does the patient consent to enroll in the GAZYVA Immunology Co-Pay Program? Yes #xD; 18-years-or-older Is the patient 18 years of age or older, or does the patient have a legal guardian 18 years of age or older to manage the program?, Yes #xD; commercial-private-insurance Is the patient on commercial (also known as private) insurance? This includes insurance from an employer and non-government funded insurance purchased from a health insurance marketplace Yes #xD; residence-state What state does the patient live in? PA #xD; receiving-medication-from-gpf Is the patient currently receiving GAZYVA from the Genentech Patient Foundation? No #xD; receiving-assistance-from-charitable-organization Is the patient currently receiving assistance from any other charitable organization for any of their out-of-pocket costs that are covered by the GAZYVA Immunology Co-pay Program? No #xD; agree-to-genentech-privacy-policy The patient acknowledges and agrees that any patient information disclosed during enrollment, including contact information, demographic information, and sensitive personal information, such as information related to the patient's medical condition, treatments, and health insurance benefits, will be shared with Genentech, the sponsor of the program, its partners, and their respective affiliates. In addition, information shared by the pharmacy/physician, such as the date the prescription was filled, the date the medication was administered by the physician (if applicable) and the amount that will be reimbursed by Genentech will also be shared. The patient authorizes Genentech to receive, use, and share the patient's personal information in connection with the GA…
questionnaire:
  v: https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234
  link: https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234
status:
  v: completed
subject:
  type:
    v: Patient
item:
  link id:
    v: consent-to-enroll
  text:
    v: Does the patient consent to enroll in the GAZYVA Immunology Co-Pay Program?
  answer:
    value: string
      v: Yes
item:
  link id:
    v: 18-years-or-older
  text:
    v: Is the patient 18 years of age or older, or does the patient have a legal guardian 18 years of age or older to manage the program?,
  answer:
    value: string
      v: Yes
item:
  link id:
    v: commercial-private-insurance
  text:
    v: Is the patient on commercial (also known as private) insurance? This includes insurance from an employer and non-government funded insurance purchased from a health insurance marketplace
  answer:
    value: string
      v: Yes
item:
  link id:
    v: residence-state
  text:
    v: What state does the patient live in?
  answer:
    value: string
      v: PA
item:
  link id:
    v: receiving-medication-from-gpf
  text:
    v: Is the patient currently receiving GAZYVA from the Genentech Patient Foundation?
  answer:
    value: string
      v: No
item:
  link id:
    v: receiving-assistance-from-charitable-organization
  text:
    v: Is the patient currently receiving assistance from any other charitable organization for any of their out-of-pocket costs that are covered by the GAZYVA Immunology Co-pay Program?
  answer:
    value: string
      v: No
item:
  link id:
    v: agree-to-genentech-privacy-policy
  text:
    v: The patient acknowledges and agrees that any patient information disclosed during enrollment, including contact information, demographic information, and sensitive personal information, such as information related to the patient's medical condition, treatments, and health insurance benefits, will be shared with Genentech, the sponsor of the program, its partners, and their respective affiliates. In addition, information shared by the pharmacy/physician, such as the date the prescription was filled, the date the medication was administered by the physician (if applicable) and the amount that will be reimbursed by Genentech will also be shared. The patient authorizes Genentech to receive, use, and share the patient's personal information in connection with the GAZYVA Immunology Co-pay Program. The patient agrees to be contacted by phone, mail, or email about the GAZYVA Immunology Co-pay Program. For more information, please see the Genentech Privacy Policy at www.gene.com/privacy-policy. To withdraw from the Program, please contact the Program at (844) 492-6729 Monday through Friday between 9am – 8pm ET.
  answer:
    value: string
      v: Agree
item:
  link id:
    v: agree-to-copay-program-terms
  text:
    v: The Co-pay Program (“Program”) is valid ONLY for patients with commercial (private or non-governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medicine. The Program is not available to patients whose prescriptions are reimbursed under any federal state, or government-funded insurance programs (included but not limited to Medicare, Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs Programs) or where prohibited by law or by the patient's health insurance provider. If at any time a patient begins receiving prescription drug coverage under any such federal, state or government-funded healthcare programs, the patient will no longer be eligible for the Program. The Program is not valid for Genentech medicines that are eligible to be reimbursed in their entirety by private insurance plans or other programs. Under the Program, the patient may be required to pay a co-pay. The final amount owed by a patient may be as little as $0 for the Genentech medicine (see Program specific details available on the Program Website). The total patient out-of-pocket cost is dependent on the patient’s health insurance plan. The Program assists with the cost of the Genentech medicine only. It does not assist with the cost of other medicines, procedures or office visit fees. After reaching the maximum annual Program benefit amount, the patient will be responsible for all remaining out-of-pocket expenses. The Program benefit amount cannot exceed the patient’s out-of-pocket expenses for the Genentech medicine. The maximum Program benefit will reset every January 1st. The Program is not health insurance or a benefit plan. The patient’s non-governmental insurance is the primary payer. The Program does not obligate the use of any specific medicine or provider. Patients receiving assistance from charitable free medicine programs (such as the Genentech Patient Foundation) or any other…
  answer:
    value: string
      v: Agree
item:
  link id:
    v: agree-to-admin-copay-program-terms
  text:
    v: The Administration Co-pay Program (“Program”) is valid ONLY for patients with commercial (private or non- governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medicine. The Program is not available to patients whose prescriptions are reimbursed under any federal state, or government-funded insurance programs (included but not limited to Medicare, Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs Programs) or where prohibited by law or by the patient's health insurance provider. If at any time a patient begins receiving prescription drug coverage under any such federal, state or government-funded healthcare programs, the patient will no longer be eligible for the Program. The Program is not valid for administration that is eligible to be reimbursed in their entirety by private insurance plans or other programs. If the patient chooses to enroll in the Drug Co-pay Program, the patient must separately enroll and meet all eligibility criteria of that program.Under the Program, the patient may be required to pay a co-pay. The final amount owed by a patient may be as little as $0 for the administration of the Genentech medicine (see Program specific details available at the Program Website). The total patient out-of-pocket cost is dependent on the patient’s health insurance plan. The Program assists with the costs of the administration of the Genentech medicine only. It does not assist with the cost of other administrations, medicines, procedures or office visit fees. After reaching the maximum per treatment or annual Program benefit amounts, the patient will be responsible for all remaining out-of-pocket expenses. The Program benefit amount cannot exceed the patient’s out-of-pocket expenses for the administration fees for the Genentech medicine. The maximum Program benefit will reset every January 1st. The Program is not health insurance or a benefit plan.…
  answer:
    value: string
      v: Agree
item:
  link id:
    v: federal-state-funded-insurance
  text:
    v: Is the patient using any federal or state-funded health care program? This includes, but is not limited to, Medicare, Medicaid, Medigap, VA, DoD and TRICARE.
  answer:
    value: string
      v: No
item:
  link id:
    v: patient-support-program
  text:
    v: Would you like to enroll in the patient support program?
  answer:
    value: string
      v: Yes
item:
  link id:
    v: information-correct
  text:
    v: All information is correct
  answer:
    value: string
      v: Yes
item:
  link id:
    v: gazyva-for-immunology-fda-approved-indications
  text:
    v: Is the patient using GAZYVA for one of the following FDA-approved indications?
  answer:
    value: Coding
      code:
        v: GAZYVA-is-a-CD20-directed-cytolytic-antibody-indicated-for-the-treatment-of-adult-patients-with-active-lupus-nephritis-(LN)-who-are-receiving-standard-therapy.
      display:
        v: GAZYVA is a CD20-directed cytolytic antibody indicated for the treatment of adult patients with active lupus nephritis (LN) who are receiving standard therapy.

urn:…
type: Coverage
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-coverage
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-coverage
text:
  status:
    v: generated
  div: Generated Narrative: Coverage 498e4f30-36ee-413e-bb1e-3ae202975bed Profile: UAPI Coverage status: Active type: health insurance plan policy subscriber: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 subscriberId: KT6WSS2PA7 beneficiary: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 period: 2025-01-01 --> (ongoing) payor: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 class type: Group value: WAR5103876 name: Group Number class type: Plan value: PPO Preferred Provider Organization name: Plan order: 1 network: Aetna
status:
  v: active
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-ActCode
    code:
      v: HIP
    display:
      v: health insurance plan policy
subscriber:
  type:
    v: RelatedPerson
subscriber id:
  v: KT6WSS2PA7
beneficiary:
  type:
    v: Patient
period:
  start:
    v: 2025-01-01
payor:
  type:
    v: Organization
class:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/coverage-class
      code:
        v: group
      display:
        v: Group
  value:
    v: WAR5103876
  name:
    v: Group Number
class:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/coverage-class
      code:
        v: plan
      display:
        v: Plan
  value:
    v: PPO Preferred Provider Organization
  name:
    v: Plan
order:
  v: 1
network:
  v: Aetna

urn:…
type: Coverage
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-coverage
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-coverage
text:
  status:
    v: generated
  div: Generated Narrative: Coverage e1d7ed46-f68b-450d-a2a4-f8a44028c7b5 Profile: UAPI Coverage status: Active type: drug policy subscriber: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 subscriberId: 4353QK230 beneficiary: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 period: 2025-01-01 --> (ongoing) payor: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 class type: RX BIN value: K345601 name: BIN class type: RX PCN value: K334455 name: PCN class type: Group value: AET123498 name: Group Number order: 2 network: CVS
status:
  v: active
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-ActCode
    code:
      v: DRUGPOL
    display:
      v: drug policy
subscriber:
  type:
    v: RelatedPerson
subscriber id:
  v: 4353QK230
beneficiary:
  type:
    v: Patient
period:
  start:
    v: 2025-01-01
payor:
  type:
    v: Organization
class:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/coverage-class
      code:
        v: rxbin
      display:
        v: RX BIN
  value:
    v: K345601
  name:
    v: BIN
class:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/coverage-class
      code:
        v: rxpcn
      display:
        v: RX PCN
  value:
    v: K334455
  name:
    v: PCN
class:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/coverage-class
      code:
        v: group
      display:
        v: Group
  value:
    v: AET123498
  name:
    v: Group Number
order:
  v: 2
network:
  v: CVS

urn:…
type: Consent
meta:
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-consent
    link: https://fhir.developer.gene.com/StructureDefinition/uapi-consent
text:
  status:
    v: generated
  div: Generated Narrative: Consent 5fea0530-ea97-4d44-8bbb-13fc6b4bf46f Profile: UAPI Consent status: Active scope: Privacy Consent category: Text Consent patient: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 dateTime: 2025-09-25 10:01:08+0000 performer: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 policyRule: HIPAA Authorization Provisions - Type * Opt Out
status:
  v: active
scope:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/consentscope
    code:
      v: patient-privacy
    display:
      v: Privacy Consent
category:
  coding: https://loinc.org/rdf/59284-0
    system:
      v: http://loinc.org
    code:
      v: 59284-0
    display:
      v: Text Consent
patient:
  type:
    v: Patient
date time:
  v: 2025-09-25T10:01:08Z
performer:
  type:
    v: Patient
policy rule:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/consentpolicycodes
    code:
      v: hipaa-auth
    display:
      v: HIPAA Authorization
provision:
  type:
    v: deny

urn:…
type: Task
text:
  status:
    v: generated
  div: Generated Narrative: Task 5fea0530-ea97-4d44-8bbb-13fc6b4bf46f status: Requested intent: plan code: Copay for: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 authoredOn: 2025-09-25 06:10:13-0500 requester: Bundle: identifier = Resource identifier: 07a9b50e-4753-417f-ae5f-993875af9533; type = message; timestamp = 2025-09-25 06:10:13-0500 input type: enroll-by-id value: Patient input type: brandId value: d0443a4a-edf1-4579-b327-01614f959f08 input type: brandId value: 97b5794c-81a0-4243-a08f-a0a07e45a982
status:
  v: requested
intent:
  v: plan
code:
  coding:
    system:
      v: https://fhir.developer.gene.com/CodeSystem/uapi-sr-type
    code:
      v: copay
for:
  type:
    v: Patient
authored on:
  v: 2025-09-25T06:10:13-05:00
requester:
  type:
    v: Organization
input:
  type:
    coding:
      system:
        v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-task-input-type
      code:
        v: enroll-by-id
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-enrollby-id
      code:
        v: 1
      display:
        v: Patient
input:
  type:
    coding:
      system:
        v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-task-input-type
      code:
        v: brandId
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-brand-id
input:
  type:
    coding:
      system:
        v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-task-input-type
      code:
        v: brandId
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-brand-id