uapi-copay-bundle-copayCRX1-PACT
type: Bundle
node role: treeRoot
id:
  v: uapi-copay-bundle-copayCRX1-PACT
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: 2020-03-11T08:10:13-05:00

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: extensions
  div: Generated Narrative: MessageHeader f8d0f28e-690f-4f24-a315-5f3b0571f79d Profile: UAPI MessageHeader UAPI MessageHeader Timestamp: 2020-03-11 08:10:13-0500 event: uapi-event-type copay-enrollment: copay-enrollment Destinations - Name Endpoint * UAPI-COPAY-ENR-V1.0 https://test-us-e1.apis.roche.com/pharma-cmg-copay-exp-test/v1/enroll sender: Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; type = message; timestamp = 2020-03-11 08:10:13-0500 Sources - Name Endpoint * Genentech PACT http://gene.com/pact focus: Bundle: identifier = Resource identifier: c600e111-c5bf-42d0-93d5-8408c1f18a38; type = message; timestamp = 2020-03-11 08:10:13-0500
extension:
  url:
    v: https://fhir.developer.gene.com/StructureDefinition/message-timestamp
  value: dateTime
    v: 2020-03-11T08:10:13-05:00
event: Coding
  system:
    v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type
  code:
    v: copay-enrollment
destination:
  name:
    v: UAPI-COPAY-ENR-V1.0
  endpoint:
    v: https://test-us-e1.apis.roche.com/pharma-cmg-copay-exp-test/v1/enroll
sender:
  type:
    v: Organization
source:
  name:
    v: Genentech PACT
  endpoint:
    v: http://gene.com/pact
focus:
  type:
    v: List

urn:…
type: List
text:
  status:
    v: generated
  div: Generated Narrative: List f603c60a-795b-47fc-981c-b49ab287f0bf messageContext Mode: Change List Status: Current Items Bundle: identifier = Resource identifier: c600e111-c5bf-42d0-93d5-8408c1f18a38; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; 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: 7c8f5054-015b-4bce-99f5-4160a82a4225; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 88b42c3d-2926-46de-b696-e8713f02f8cb; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500 Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 88b42c3d-2926-46de-b696-e8713f02f8cb; type = message; timestamp = 2020-03-11 08:10:13-0500 Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; type = message; timestamp = 2020-03-11 08:10:13-0500
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: QuestionnaireResponse
entry:
  item:
    type:
      v: Coverage
entry:
  item:
    type:
      v: Coverage
entry:
  item:
    type:
      v: Task
entry:
  item:
    type:
      v: RelatedPerson

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 1a4935bd-289b-4f11-82bf-a86d10792af4 Profile: UAPI Patient Ryan Michaelson (official) Male, DoB: 1972-10-29 ( Patient internal identifier: 6bcd8467-0473-4836-9128-2e7972f23177 (use: usual, )) Other Id: Patient internal identifier/PAT-123 (use: usual, ) 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: 7c8f5054-015b-4bce-99f5-4160a82a4225; type = message; timestamp = 2020-03-11 08:10:13-0500 Managing Organization: Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; type = message; timestamp = 2020-03-11 08:10:13-0500
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://gene.com/pact
  value:
    v: PAT-123
  assigner:
    display:
      v: Genentech PACT
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://gene.com/patientmaster
  assigner:
    display:
      v: Genentech Patient Master
name:
  use:
    v: official
  family:
    v: Michaelson
  given:
    v: Ryan
telecom:
  system:
    v: phone
  value:
    v: 1231231234
  use:
    v: home
  rank:
    v: 1
telecom:
  system:
    v: phone
  value:
    v: 1234561234
  use:
    v: mobile
  rank:
    v: 2
telecom:
  system:
    v: email
  use:
    v: home
  rank:
    v: 3
gender:
  v: male
birth date:
  v: 1972-10-29
address:
  line:
    v: 1234 Main St
  city:
    v: San Francisco
  state:
    v: CA
  postal code:
    v: 94105
  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 be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2 Profile: UAPI Organization identifier: http://vendor.com/ab/HOSP-12345 (use: usual, ), National provider identifier/1922071448 (use: usual, ) type: Healthcare Provider name: Cleveland Clinic telecom: ph: 8882704882(Work) address: 8 Ranoldo Terrace Cherry Hill NJ 08034 US Contacts - Name Telecom * MARISSA CRUZ (Official) ph: -unknown-
identifier:
  use:
    v: usual
  system:
    v: http://vendor.com/ab
  value:
    v: HOSP-12345
  assigner:
    display:
      v: AB Vendor
identifier:
  use:
    v: usual
  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: 1922071448
  assigner:
    display:
      v: Cleveland Clinic
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
address:
  line:
    v: 8 Ranoldo Terrace
  city:
    v: Cherry Hill
  state:
    v: NJ
  postal code:
    v: 08034
  country:
    v: US
contact:
  name:
    use:
      v: official
    family:
      v: CRUZ
    given:
      v: MARISSA
  telecom:
    system:
      v: phone

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 d3637025-883d-4678-9e0a-1d243a338f9f Profile: UAPI Organization identifier: http://vendor.com/ab/PAY-111 (use: usual, ) type: Insurance Company name: Kaiser telecom: ph: 8778472862(Work)
identifier:
  use:
    v: usual
  system:
    v: http://vendor.com/ab
  value:
    v: PAY-111
  assigner:
    display:
      v: AB Vendor
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/organization-type
    code:
      v: ins
name:
  v: Kaiser
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 982e97af-668d-41ef-b9f9-2bbc4a059330 Profile: UAPI Organization identifier: http://vendor.com/ab/PAY-145 (use: usual, ) type: Insurance Company name: CVS Specialty telecom: ph: -unknown- Contacts - Telecom * ph: 8778472862(Work)
identifier:
  use:
    v: usual
  system:
    v: http://vendor.com/ab
  value:
    v: PAY-145
  assigner:
    display:
      v: Ph Vendor
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/organization-type
    code:
      v: ins
name:
  v: CVS Specialty
telecom:
  system:
    v: phone
contact:
  telecom:
    system:
      v: phone
    value:
      v: 8778472862
    use:
      v: work
    rank:
      v: 1

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: extensions
  div: Generated Narrative: Practitioner cc31cf51-ea4f-4623-bdbb-2ea9e0068a20 Profile: UAPI Practitioner UAPI Practitioner Preferred Contact Method: work-phone UAPI Practitioner Shipment Method: morning identifier: Provider identifier/1922071448 (use: official, ), National provider identifier/1639285034 (use: official, ) name: MARISSA ANNE CRUZ (Official) telecom: ph: 8882704882(Work), fax: 8882704883(Work), prescribercopay@example.com address: 8 Ranoldo Terrace Cherry Hill NJ 08034 US Qualifications - Code * Doctor of Medicine
extension:
  url:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-preferred-contact-method
  value: CodeableConcept
    coding:
      system:
        v: https://fhir.developer.gene.com/CodeSystem/prescriber-contact-method
      code:
        v: work-phone
extension:
  url:
    v: https://fhir.developer.gene.com/StructureDefinition/uapi-preferred-contact-time
  value: CodeableConcept
    coding:
      system:
        v: https://fhir.developer.gene.com/CodeSystem/prescriber-contact-time
      code:
        v: morning
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
  given:
    v: ANNE
  prefix:
    v: Dr
  suffix:
    v: Junior
telecom:
  system:
    v: phone
  value:
    v: 8882704882
  use:
    v: work
  rank:
    v: 1
telecom:
  system:
    v: fax
  value:
    v: 8882704883
  use:
    v: work
  rank:
    v: 2
telecom:
  system:
    v: email
  use:
    v: work
  rank:
    v: 3
address:
  line:
    v: 8 Ranoldo Terrace
  city:
    v: Cherry Hill
  state:
    v: NJ
  postal code:
    v: 08034
  country:
    v: US
qualification:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0360
      code:
        v: MD

urn:…
type: QuestionnaireResponse
text:
  status:
    v: generated
  div: Generated Narrative: QuestionnaireResponse c29782b4-6ffc-494e-85ab-eee27bfd994a LinkID Text Definition Answer<img src="[binary]" alt="doco" style="background-color: inherit"/> c29782b4-6ffc-494e-85ab-eee27bfd994a Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234 #xD; consent-to-enroll Does the patient consent to enroll in the Ocrevus Co-Pay Program? Yes #xD; ocrevus-fda-approved-indications Is the patient using OCREVUS for the following FDA-approved indications? [not stated] Relapsing-forms-of-multiple-sclerosis-(MS),-to-include-clinically-isolated-syndrome,-relapsing-remitting-disease-and-active-secondary-progressive-disease-or-primary-progressive-forms-of-MS,-in-adults: Relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease and active secondary progressive disease or primary progressive forms of MS, in adults #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; federal-state-funded-insurance 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. No #xD; have-medicare-card Does the patient have a Medicare (red, white and blue) card? Yes #xD; enter-medicare-number Enter the Medicare number: M577788 #xD; residence-state What state does the patient live in? CA #xD; receiving-medication-from-gpf Is the patient currently receiving Ocrevus 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…
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 Ocrevus Co-Pay Program?
  answer:
    value: string
      v: Yes
item:
  link id:
    v: ocrevus-fda-approved-indications
  text:
    v: Is the patient using OCREVUS for the following FDA-approved indications?
  answer:
    value: Coding
      code:
        v: Relapsing-forms-of-multiple-sclerosis-(MS),-to-include-clinically-isolated-syndrome,-relapsing-remitting-disease-and-active-secondary-progressive-disease-or-primary-progressive-forms-of-MS,-in-adults
      display:
        v: Relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease and active secondary progressive disease or primary progressive forms of MS, in adults
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: 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: have-medicare-card
  text:
    v: Does the patient have a Medicare (red, white and blue) card?
  answer:
    value: string
      v: Yes
item:
  link id:
    v: enter-medicare-number
  text:
    v: Enter the Medicare number:
  answer:
    value: string
      v: M577788
item:
  link id:
    v: residence-state
  text:
    v: What state does the patient live in?
  answer:
    value: string
      v: CA
item:
  link id:
    v: receiving-medication-from-gpf
  text:
    v: Is the patient currently receiving Ocrevus 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 Ocrevus 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 the enrollment, including contact information, demographic information, and information related to their medical condition, treatments, and health insurance and 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 patient personal information in connection with the Ocrevus Co-pay Program. The patient agrees to be contacted by phone, mail or email about the Ocrevus Co-pay Program. You have notified the patient that they can find more information in the Genentech Privacy Policy at www.gene.com/privacy-policy.
  answer:
    value: string
      v: Agree
item:
  link id:
    v: agree-to-copay-program-terms
  text:
    v: The Co-pay 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. Patients using Medicare, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD), TRICARE or any other federal or state government program (collectively, “Government Programs”) to pay for their Genentech medicine are not eligible. 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 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). 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 cost associated with 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 charitable organizations for the same expenses covered by the Program are not eligible. The Program benefit cannot be combined with any other rebate, free trial or a similar offer for the Genentech medicine. No party may seek reimbursement for all or any part of the benefit received through the Program. The Program may be accepted by parti…
item:
  link id:
    v: agree-to-admin-copay-program-terms
  text:
    v: The Administration Co-pay 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. Patients using Medicare, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD), TRICARE or any other federal or state government program (collectively, “Government Programs”) to pay for their Genentech medicine and/or administration services are not eligible. 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 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). 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 associated with 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. The Program is valid for patients receiving free medicine from the Genentech Patient Foundation. The Program is not valid for patients receiving assistance from any other charitable or…
  answer:
    value: string
      v: Agree
item:
  link id:
    v: information-correct
  text:
    v: All information is correct?
  answer:
    value: string
      v: Yes

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 42b41bdb-1781-49aa-a091-78cdd92129df Profile: UAPI Coverage status: Active type: health insurance plan policy subscriber: Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; 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 period: 2023-01-01 --> (ongoing) payor: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 class type: RX BIN value: K12345 name: BIN class type: RX PCN value: K234516 name: PCN class type: Group value: KAI2345 name: Group Number class type: Plan value: HMO name: Plan order: 1 network: Kaiser
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: 4353
beneficiary:
  type:
    v: Patient
period:
  start:
    v: 2023-01-01
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: K12345
  name:
    v: BIN
class:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/coverage-class
      code:
        v: rxpcn
      display:
        v: RX PCN
  value:
    v: K234516
  name:
    v: PCN
class:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/coverage-class
      code:
        v: group
      display:
        v: Group
  value:
    v: KAI2345
  name:
    v: Group Number
class:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/coverage-class
      code:
        v: plan
      display:
        v: Plan
  value:
    v: HMO
  name:
    v: Plan
order:
  v: 1
network:
  v: Kaiser

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 d212ac11-903c-4040-a3d7-6b3e1874a311 Profile: UAPI Coverage status: Active type: drug policy subscriber: Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; 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 period: 2023-01-01 --> (ongoing) payor: Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; type = message; timestamp = 2020-03-11 08:10:13-0500 class type: RX BIN value: K3456 name: BIN class type: RX PCN value: K334455 name: PCN class type: Group value: KAI2345 name: Group Number class type: Plan value: HMO name: Plan order: 1 network: CVS Specialty
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: 4353
beneficiary:
  type:
    v: Patient
period:
  start:
    v: 2023-01-01
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: K3456
  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: KAI2345
  name:
    v: Group Number
class:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/coverage-class
      code:
        v: plan
      display:
        v: Plan
  value:
    v: HMO
  name:
    v: Plan
order:
  v: 1
network:
  v: CVS Specialty

urn:…
type: Task
text:
  status:
    v: generated
  div: Generated Narrative: Task 72d8daf1-f80f-4e56-bfcb-0558caf74feb status: Requested intent: plan code: Copay for: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 authoredOn: 2023-01-23 08:10:13-0500 requester: Bundle: identifier = Resource identifier: 7c8f5054-015b-4bce-99f5-4160a82a4225; type = message; timestamp = 2020-03-11 08:10:13-0500 input type: enroll-by-id value: Patient input type: brandId value: 8699576a-3247-429a-9e46-31c00f50f1a0 input type: brandId value: 2e340749-5d09-4615-b0cf-29cb13d30972
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: 2023-01-23T08:10:13-05:00
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

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 12ed44e8-fde2-415d-9dcc-8e9117c73d2a 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: 310-462-1234(Mobile) birthDate: 1972-10-29 address: 8 Ranoldo Terrace Cherry Hill NJ 08034 US
patient:
  type:
    v: Patient
relationship:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-RoleCode
    code:
      v: SIGOTHR
    display:
      v: significant other
name:
  use:
    v: official
  family:
    v: Smith
  given:
    v: Bob Paul
telecom:
  system:
    v: phone
  value:
    v: 310-462-1234
  use:
    v: mobile
birth date:
  v: 1972-10-29
address:
  line:
    v: 8 Ranoldo Terrace
  city:
    v: Cherry Hill
  state:
    v: NJ
  postal code:
    v: 08034
  country:
    v: US