Alisia5_Ziemann98_b177c416-9498-48f4-a1dd-86646819fe4a.json•622 kB
{
"resourceType": "Bundle",
"type": "transaction",
"entry": [
{
"fullUrl": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"resource": {
"resourceType": "Patient",
"id": "b177c416-9498-48f4-a1dd-86646819fe4a",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated by <a href=\"https://github.com/synthetichealth/synthea\">Synthea</a>.Version identifier: 65d0325\n . Person seed: 9130032384872729413 Population seed: 1759830027971</div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2106-3",
"display": "White"
}
},
{
"url": "text",
"valueString": "White"
}
]
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2186-5",
"display": "Not Hispanic or Latino"
}
},
{
"url": "text",
"valueString": "Not Hispanic or Latino"
}
]
},
{
"url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
"valueString": "Leonora414 Abernathy524"
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
"valueCode": "F"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
"valueAddress": {
"city": "Weymouth",
"state": "Massachusetts",
"country": "US"
}
},
{
"url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
"valueDecimal": 2.575804801067353
},
{
"url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
"valueDecimal": 65.42419519893265
}
],
"identifier": [
{
"system": "https://github.com/synthetichealth/synthea",
"value": "b177c416-9498-48f4-a1dd-86646819fe4a"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR",
"display": "Medical Record Number"
}
],
"text": "Medical Record Number"
},
"system": "http://hospital.smarthealthit.org",
"value": "b177c416-9498-48f4-a1dd-86646819fe4a"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "SS",
"display": "Social Security Number"
}
],
"text": "Social Security Number"
},
"system": "http://hl7.org/fhir/sid/us-ssn",
"value": "999-95-9456"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "DL",
"display": "Driver's License"
}
],
"text": "Driver's License"
},
"system": "urn:oid:2.16.840.1.113883.4.3.25",
"value": "S99987850"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "PPN",
"display": "Passport Number"
}
],
"text": "Passport Number"
},
"system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber",
"value": "X75188913X"
}
],
"name": [
{
"use": "official",
"family": "Ziemann98",
"given": [
"Alisia5"
],
"prefix": [
"Mrs."
]
},
{
"use": "maiden",
"family": "Dietrich576",
"given": [
"Alisia5"
],
"prefix": [
"Mrs."
]
}
],
"telecom": [
{
"system": "phone",
"value": "555-959-1028",
"use": "home"
}
],
"gender": "female",
"birthDate": "1956-03-15",
"address": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/geolocation",
"extension": [
{
"url": "latitude",
"valueDecimal": 42.19546947340673
},
{
"url": "longitude",
"valueDecimal": -71.56758587866861
}
]
}
],
"line": [
"484 Lubowitz Burg Unit 26"
],
"city": "Milford",
"state": "Massachusetts",
"country": "US"
}
],
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M",
"display": "M"
}
],
"text": "M"
},
"multipleBirthBoolean": false,
"communication": [
{
"language": {
"coding": [
{
"system": "urn:ietf:bcp:47",
"code": "en-US",
"display": "English"
}
],
"text": "English"
}
}
]
},
"request": {
"method": "POST",
"url": "Patient"
}
},
{
"fullUrl": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"resource": {
"resourceType": "Organization",
"id": "b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"identifier": [
{
"system": "https://github.com/synthetichealth/synthea",
"value": "b0d46e53-6b47-354a-9ddb-9ed9302ae9f5"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "prov",
"display": "Healthcare Provider"
}
],
"text": "Healthcare Provider"
}
],
"name": "PCP114062",
"address": [
{
"line": [
"77 W MAIN ST"
],
"city": "HOPKINTON",
"state": "MA",
"postalCode": "01748-1684",
"country": "US"
}
]
},
"request": {
"method": "POST",
"url": "Organization"
}
},
{
"fullUrl": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"resource": {
"resourceType": "Practitioner",
"id": "00000199-be0b-2ec3-0000-00000000b2e8",
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "45800"
}
],
"active": true,
"name": [
{
"family": "Lebsack687",
"given": [
"Fritz267"
],
"prefix": [
"Dr."
]
}
],
"telecom": [
{
"system": "email",
"value": "Fritz267.Lebsack687@example.com",
"use": "work"
}
],
"address": [
{
"line": [
"77 W MAIN ST"
],
"city": "HOPKINTON",
"state": "MA",
"postalCode": "01748-1684",
"country": "US"
}
],
"gender": "male"
},
"request": {
"method": "POST",
"url": "Practitioner"
}
},
{
"fullUrl": "urn:uuid:e622a508-d2e0-482a-9239-b665d007ed89",
"resource": {
"resourceType": "Encounter",
"id": "e622a508-d2e0-482a-9239-b665d007ed89",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "1993-06-03T19:34:29+00:00",
"end": "1993-06-03T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:f7c9324b-86c9-49a2-81ff-31567045d3dc",
"resource": {
"resourceType": "Condition",
"id": "f7c9324b-86c9-49a2-81ff-31567045d3dc",
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162864005",
"display": "Body mass index 30+ - obesity (finding)"
}
],
"text": "Body mass index 30+ - obesity (finding)"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:e622a508-d2e0-482a-9239-b665d007ed89"
},
"onsetDateTime": "1993-06-03T19:34:29+00:00",
"recordedDate": "1993-06-03T19:34:29+00:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "urn:uuid:0cfff7a5-a9df-4e07-86ca-5d7ddb3fcf50",
"resource": {
"resourceType": "Claim",
"id": "0cfff7a5-a9df-4e07-86ca-5d7ddb3fcf50",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "1993-06-03T19:34:29+00:00",
"end": "1993-06-03T19:49:29+00:00"
},
"created": "1993-06-03T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:f7c9324b-86c9-49a2-81ff-31567045d3dc"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Aetna"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:e622a508-d2e0-482a-9239-b665d007ed89"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162864005",
"display": "Body mass index 30+ - obesity (finding)"
}
],
"text": "Body mass index 30+ - obesity (finding)"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:220a65c2-ecc6-4a11-bf75-d2fc9c2621fc",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "220a65c2-ecc6-4a11-bf75-d2fc9c2621fc",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Aetna"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Aetna"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "0cfff7a5-a9df-4e07-86ca-5d7ddb3fcf50"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "1993-06-03T19:49:29+00:00",
"end": "1994-06-03T19:49:29+00:00"
},
"created": "1993-06-03T19:49:29+00:00",
"insurer": {
"display": "Aetna"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:0cfff7a5-a9df-4e07-86ca-5d7ddb3fcf50"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:f7c9324b-86c9-49a2-81ff-31567045d3dc"
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
}
]
}
]
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Aetna"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "1993-06-03T19:34:29+00:00",
"end": "1993-06-03T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:e622a508-d2e0-482a-9239-b665d007ed89"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162864005",
"display": "Body mass index 30+ - obesity (finding)"
}
],
"text": "Body mass index 30+ - obesity (finding)"
},
"servicedPeriod": {
"start": "1993-06-03T19:34:29+00:00",
"end": "1993-06-03T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
}
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:50a84d00-2f99-479a-8ab1-80994a40ae4f",
"resource": {
"resourceType": "Encounter",
"id": "50a84d00-2f99-479a-8ab1-80994a40ae4f",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "1996-03-21T19:34:29+00:00",
"end": "1996-03-21T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:346bc72d-a2ea-4986-8c50-cc203242a998",
"resource": {
"resourceType": "Condition",
"id": "346bc72d-a2ea-4986-8c50-cc203242a998",
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "15777000",
"display": "Prediabetes"
}
],
"text": "Prediabetes"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:50a84d00-2f99-479a-8ab1-80994a40ae4f"
},
"onsetDateTime": "1996-03-21T19:34:29+00:00",
"recordedDate": "1996-03-21T19:34:29+00:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "urn:uuid:7d8d14c7-119e-439c-93af-f33e18e36a93",
"resource": {
"resourceType": "CareTeam",
"id": "7d8d14c7-119e-439c-93af-f33e18e36a93",
"status": "active",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:50a84d00-2f99-479a-8ab1-80994a40ae4f"
},
"period": {
"start": "1996-03-21T19:34:29+00:00"
},
"participant": [
{
"role": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "116153009",
"display": "Patient"
}
],
"text": "Patient"
}
],
"member": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
}
},
{
"role": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "303118004",
"display": "Person in the healthcare environment (person)"
}
],
"text": "Person in the healthcare environment (person)"
}
],
"member": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
},
{
"role": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "303118004",
"display": "Healthcare related organization (qualifier value)"
}
],
"text": "Healthcare related organization (qualifier value)"
}
],
"member": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
}
],
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "15777000",
"display": "Prediabetes"
}
],
"text": "Prediabetes"
}
],
"managingOrganization": [
{
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
]
},
"request": {
"method": "POST",
"url": "CareTeam"
}
},
{
"fullUrl": "urn:uuid:abfcc723-e27f-4719-b4fb-a571570e14da",
"resource": {
"resourceType": "Goal",
"id": "abfcc723-e27f-4719-b4fb-a571570e14da",
"lifecycleStatus": "accepted",
"achievementStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/goal-achievement",
"code": "in-progress"
}
]
},
"description": {
"text": "Hemoglobin A1c total in Blood < 7.0"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"target": [
{
"measure": {
"text": "Hemoglobin A1c total in Blood < 7.0"
},
"dueDate": "1996-04-20"
}
]
},
"request": {
"method": "POST",
"url": "Goal"
}
},
{
"fullUrl": "urn:uuid:b2f44158-8628-4861-8500-ed0881432d14",
"resource": {
"resourceType": "Goal",
"id": "b2f44158-8628-4861-8500-ed0881432d14",
"lifecycleStatus": "accepted",
"achievementStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/goal-achievement",
"code": "in-progress"
}
]
},
"description": {
"text": "Glucose [Mass/volume] in Blood < 108"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"target": [
{
"measure": {
"text": "Glucose [Mass/volume] in Blood < 108"
},
"dueDate": "1996-04-20"
}
]
},
"request": {
"method": "POST",
"url": "Goal"
}
},
{
"fullUrl": "urn:uuid:b28dfbcf-a1d4-4695-a216-e1ae5b662adb",
"resource": {
"resourceType": "Goal",
"id": "b28dfbcf-a1d4-4695-a216-e1ae5b662adb",
"lifecycleStatus": "accepted",
"achievementStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/goal-achievement",
"code": "in-progress"
}
]
},
"description": {
"text": "Maintain blood pressure below 140/90 mmHg"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"target": [
{
"measure": {
"text": "Maintain blood pressure below 140/90 mmHg"
},
"dueDate": "1996-04-20"
}
]
},
"request": {
"method": "POST",
"url": "Goal"
}
},
{
"fullUrl": "urn:uuid:2129bf83-cc24-46e8-b436-46a2b00601fd",
"resource": {
"resourceType": "Goal",
"id": "2129bf83-cc24-46e8-b436-46a2b00601fd",
"lifecycleStatus": "accepted",
"achievementStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/goal-achievement",
"code": "in-progress"
}
]
},
"description": {
"text": "Improve and maintenance of optimal foot health: aim at early detection of peripheral vascular problems and neuropathy presumed due to diabetes; and prevention of diabetic foot ulcer, gangrene"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"target": [
{
"measure": {
"text": "Improve and maintenance of optimal foot health: aim at early detection of peripheral vascular problems and neuropathy presumed due to diabetes; and prevention of diabetic foot ulcer, gangrene"
},
"dueDate": "1996-04-20"
}
]
},
"request": {
"method": "POST",
"url": "Goal"
}
},
{
"fullUrl": "urn:uuid:d4a8f60d-c6ca-4982-91dc-48419e3e8d8d",
"resource": {
"resourceType": "Goal",
"id": "d4a8f60d-c6ca-4982-91dc-48419e3e8d8d",
"lifecycleStatus": "accepted",
"achievementStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/goal-achievement",
"code": "in-progress"
}
]
},
"description": {
"text": "Address patient knowledge deficit on diabetic self-care"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"target": [
{
"measure": {
"text": "Address patient knowledge deficit on diabetic self-care"
},
"dueDate": "1996-04-20"
}
]
},
"request": {
"method": "POST",
"url": "Goal"
}
},
{
"fullUrl": "urn:uuid:34fcfd01-b6cf-4b25-aae4-a2e62e93a14b",
"resource": {
"resourceType": "CarePlan",
"id": "34fcfd01-b6cf-4b25-aae4-a2e62e93a14b",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Care Plan for Diabetes self management plan.<br/>Activities: <ul><li>Diabetes self management plan</li><li>Diabetes self management plan</li></ul><br/>Care plan is meant to treat Prediabetes.</div>"
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "698360004",
"display": "Diabetes self management plan"
}
],
"text": "Diabetes self management plan"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:50a84d00-2f99-479a-8ab1-80994a40ae4f"
},
"period": {
"start": "1996-03-21T19:34:29+00:00"
},
"careTeam": [
{
"reference": "urn:uuid:7d8d14c7-119e-439c-93af-f33e18e36a93"
}
],
"addresses": [
{
"reference": "urn:uuid:346bc72d-a2ea-4986-8c50-cc203242a998"
}
],
"goal": [
{
"reference": "urn:uuid:abfcc723-e27f-4719-b4fb-a571570e14da"
},
{
"reference": "urn:uuid:b2f44158-8628-4861-8500-ed0881432d14"
},
{
"reference": "urn:uuid:b28dfbcf-a1d4-4695-a216-e1ae5b662adb"
},
{
"reference": "urn:uuid:2129bf83-cc24-46e8-b436-46a2b00601fd"
},
{
"reference": "urn:uuid:d4a8f60d-c6ca-4982-91dc-48419e3e8d8d"
}
],
"activity": [
{
"detail": {
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "160670007",
"display": "Diabetic diet"
}
],
"text": "Diabetic diet"
},
"status": "in-progress",
"location": {
"display": "PCP114062"
}
}
},
{
"detail": {
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "229065009",
"display": "Exercise therapy"
}
],
"text": "Exercise therapy"
},
"status": "in-progress",
"location": {
"display": "PCP114062"
}
}
}
]
},
"request": {
"method": "POST",
"url": "CarePlan"
}
},
{
"fullUrl": "urn:uuid:38d6756a-073a-49f1-b44a-abab736dd4b1",
"resource": {
"resourceType": "Claim",
"id": "38d6756a-073a-49f1-b44a-abab736dd4b1",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "1996-03-21T19:34:29+00:00",
"end": "1996-03-21T19:49:29+00:00"
},
"created": "1996-03-21T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:346bc72d-a2ea-4986-8c50-cc203242a998"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Aetna"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:50a84d00-2f99-479a-8ab1-80994a40ae4f"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "15777000",
"display": "Prediabetes"
}
],
"text": "Prediabetes"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:725144cb-eb0b-4aca-92e6-011e01954e75",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "725144cb-eb0b-4aca-92e6-011e01954e75",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Aetna"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Aetna"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "38d6756a-073a-49f1-b44a-abab736dd4b1"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "1996-03-21T19:49:29+00:00",
"end": "1997-03-21T19:49:29+00:00"
},
"created": "1996-03-21T19:49:29+00:00",
"insurer": {
"display": "Aetna"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:38d6756a-073a-49f1-b44a-abab736dd4b1"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:346bc72d-a2ea-4986-8c50-cc203242a998"
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
}
]
}
]
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Aetna"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "1996-03-21T19:34:29+00:00",
"end": "1996-03-21T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:50a84d00-2f99-479a-8ab1-80994a40ae4f"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "15777000",
"display": "Prediabetes"
}
],
"text": "Prediabetes"
},
"servicedPeriod": {
"start": "1996-03-21T19:34:29+00:00",
"end": "1996-03-21T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
}
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:3a83eff5-5deb-4813-87f6-4c573f83f9ee",
"resource": {
"resourceType": "Encounter",
"id": "3a83eff5-5deb-4813-87f6-4c573f83f9ee",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "2000-03-30T19:34:29+00:00",
"end": "2000-03-30T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:6325c3f3-7d5a-44f7-957b-2205587e53ec",
"resource": {
"resourceType": "Condition",
"id": "6325c3f3-7d5a-44f7-957b-2205587e53ec",
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "271737000",
"display": "Anemia (disorder)"
}
],
"text": "Anemia (disorder)"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3a83eff5-5deb-4813-87f6-4c573f83f9ee"
},
"onsetDateTime": "2000-03-30T19:34:29+00:00",
"recordedDate": "2000-03-30T19:34:29+00:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "urn:uuid:e40bc34e-d8cc-4bd6-b280-77717e0cc59f",
"resource": {
"resourceType": "Claim",
"id": "e40bc34e-d8cc-4bd6-b280-77717e0cc59f",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2000-03-30T19:34:29+00:00",
"end": "2000-03-30T19:49:29+00:00"
},
"created": "2000-03-30T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:6325c3f3-7d5a-44f7-957b-2205587e53ec"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:3a83eff5-5deb-4813-87f6-4c573f83f9ee"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "271737000",
"display": "Anemia (disorder)"
}
],
"text": "Anemia (disorder)"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:1a8ff338-b87d-489b-8046-bf089d1386c4",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "1a8ff338-b87d-489b-8046-bf089d1386c4",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Medicaid"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "e40bc34e-d8cc-4bd6-b280-77717e0cc59f"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2000-03-30T19:49:29+00:00",
"end": "2001-03-30T19:49:29+00:00"
},
"created": "2000-03-30T19:49:29+00:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:e40bc34e-d8cc-4bd6-b280-77717e0cc59f"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:6325c3f3-7d5a-44f7-957b-2205587e53ec"
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
}
]
}
]
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2000-03-30T19:34:29+00:00",
"end": "2000-03-30T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:3a83eff5-5deb-4813-87f6-4c573f83f9ee"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "271737000",
"display": "Anemia (disorder)"
}
],
"text": "Anemia (disorder)"
},
"servicedPeriod": {
"start": "2000-03-30T19:34:29+00:00",
"end": "2000-03-30T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
}
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2",
"resource": {
"resourceType": "Encounter",
"id": "91806d4e-d8ea-4a0f-a285-92e96d27f7a2",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "2016-05-12T19:34:29+00:00",
"end": "2016-05-12T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:57bc90fc-9bbb-43b8-b4f6-bc51bf8aabf1",
"resource": {
"resourceType": "Observation",
"id": "57bc90fc-9bbb-43b8-b4f6-bc51bf8aabf1",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height"
}
],
"text": "Body Height"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 172.7,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:f7c713f6-6298-4a85-9e27-6a412f55f0f3",
"resource": {
"resourceType": "Observation",
"id": "f7c713f6-6298-4a85-9e27-6a412f55f0f3",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72514-3",
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
}
],
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:ec6fddb2-ffea-4b53-a06a-2abc4c4a03e3",
"resource": {
"resourceType": "Observation",
"id": "ec6fddb2-ffea-4b53-a06a-2abc4c4a03e3",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "29463-7",
"display": "Body Weight"
}
],
"text": "Body Weight"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 81.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:3c6782c3-97f4-4837-bcd8-3d125716e713",
"resource": {
"resourceType": "Observation",
"id": "3c6782c3-97f4-4837-bcd8-3d125716e713",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body Mass Index"
}
],
"text": "Body Mass Index"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.23,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:4533ebdd-551f-49ae-a84c-9d4076d975de",
"resource": {
"resourceType": "Observation",
"id": "4533ebdd-551f-49ae-a84c-9d4076d975de",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "85354-9",
"display": "Blood Pressure"
}
],
"text": "Blood Pressure"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 86,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 136,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:33049e08-cf1b-4185-b2d6-4c960015b927",
"resource": {
"resourceType": "Observation",
"id": "33049e08-cf1b-4185-b2d6-4c960015b927",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2339-0",
"display": "Glucose"
}
],
"text": "Glucose"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 64.54,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:9689ec91-bc0a-4da0-a7ff-a88bd01105c9",
"resource": {
"resourceType": "Observation",
"id": "9689ec91-bc0a-4da0-a7ff-a88bd01105c9",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6299-2",
"display": "Urea Nitrogen"
}
],
"text": "Urea Nitrogen"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 11.84,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:54c0a4a9-6051-447a-a31e-547bb70617d3",
"resource": {
"resourceType": "Observation",
"id": "54c0a4a9-6051-447a-a31e-547bb70617d3",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "38483-4",
"display": "Creatinine"
}
],
"text": "Creatinine"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 0.89,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:7762778b-a51c-4964-b857-4b815afdea75",
"resource": {
"resourceType": "Observation",
"id": "7762778b-a51c-4964-b857-4b815afdea75",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "49765-1",
"display": "Calcium"
}
],
"text": "Calcium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 9.98,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:ceca27cb-9dbd-4d06-a1c6-0ce3983c07aa",
"resource": {
"resourceType": "Observation",
"id": "ceca27cb-9dbd-4d06-a1c6-0ce3983c07aa",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2947-0",
"display": "Sodium"
}
],
"text": "Sodium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 138.7,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:082a2e37-605c-42a6-8f15-2d56269cb9dd",
"resource": {
"resourceType": "Observation",
"id": "082a2e37-605c-42a6-8f15-2d56269cb9dd",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6298-4",
"display": "Potassium"
}
],
"text": "Potassium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 4.43,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:08d8906c-1009-48ed-8699-bfe7e3d22a24",
"resource": {
"resourceType": "Observation",
"id": "08d8906c-1009-48ed-8699-bfe7e3d22a24",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2069-3",
"display": "Chloride"
}
],
"text": "Chloride"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 108.86,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:a56641ec-0c0d-4912-8b03-77c83c701743",
"resource": {
"resourceType": "Observation",
"id": "a56641ec-0c0d-4912-8b03-77c83c701743",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "20565-8",
"display": "Carbon Dioxide"
}
],
"text": "Carbon Dioxide"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 23.64,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:31bab890-ad3d-419f-a3f5-106a8cabbb68",
"resource": {
"resourceType": "Observation",
"id": "31bab890-ad3d-419f-a3f5-106a8cabbb68",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72166-2",
"display": "Tobacco smoking status NHIS"
}
],
"text": "Tobacco smoking status NHIS"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Former smoker"
}
],
"text": "Former smoker"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:a564ac41-d94b-4739-b9bd-b51bb836d740",
"resource": {
"resourceType": "Observation",
"id": "a564ac41-d94b-4739-b9bd-b51bb836d740",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
}
],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"valueQuantity": {
"value": 6.05,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:1bff1b23-235f-449a-988b-217301e0c91e",
"resource": {
"resourceType": "Immunization",
"id": "1bff1b23-235f-449a-988b-217301e0c91e",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"occurrenceDateTime": "2016-05-12T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:2763f35e-7503-4845-a608-f1a7fd950504",
"resource": {
"resourceType": "DiagnosticReport",
"id": "2763f35e-7503-4845-a608-f1a7fd950504",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic Metabolic Panel"
}
],
"text": "Basic Metabolic Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
},
"effectiveDateTime": "2016-05-12T19:34:29+00:00",
"issued": "2016-05-12T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:33049e08-cf1b-4185-b2d6-4c960015b927",
"display": "Glucose"
},
{
"reference": "urn:uuid:9689ec91-bc0a-4da0-a7ff-a88bd01105c9",
"display": "Urea Nitrogen"
},
{
"reference": "urn:uuid:54c0a4a9-6051-447a-a31e-547bb70617d3",
"display": "Creatinine"
},
{
"reference": "urn:uuid:7762778b-a51c-4964-b857-4b815afdea75",
"display": "Calcium"
},
{
"reference": "urn:uuid:ceca27cb-9dbd-4d06-a1c6-0ce3983c07aa",
"display": "Sodium"
},
{
"reference": "urn:uuid:082a2e37-605c-42a6-8f15-2d56269cb9dd",
"display": "Potassium"
},
{
"reference": "urn:uuid:08d8906c-1009-48ed-8699-bfe7e3d22a24",
"display": "Chloride"
},
{
"reference": "urn:uuid:a56641ec-0c0d-4912-8b03-77c83c701743",
"display": "Carbon Dioxide"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:eafdf3ea-fd48-4639-a550-ba7637a7a3e2",
"resource": {
"resourceType": "Claim",
"id": "eafdf3ea-fd48-4639-a550-ba7637a7a3e2",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2016-05-12T19:34:29+00:00",
"end": "2016-05-12T19:49:29+00:00"
},
"created": "2016-05-12T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:1bff1b23-235f-449a-988b-217301e0c91e"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 140.52,
"currency": "USD"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:bfc311ed-5a5b-4ecb-baa8-88bfbad220e8",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "bfc311ed-5a5b-4ecb-baa8-88bfbad220e8",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Humana"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Humana"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "eafdf3ea-fd48-4639-a550-ba7637a7a3e2"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2016-05-12T19:49:29+00:00",
"end": "2017-05-12T19:49:29+00:00"
},
"created": "2016-05-12T19:49:29+00:00",
"insurer": {
"display": "Humana"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:eafdf3ea-fd48-4639-a550-ba7637a7a3e2"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2016-05-12T19:34:29+00:00",
"end": "2016-05-12T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:91806d4e-d8ea-4a0f-a285-92e96d27f7a2"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2016-05-12T19:34:29+00:00",
"end": "2016-05-12T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9",
"resource": {
"resourceType": "Encounter",
"id": "3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "2017-05-18T19:34:29+00:00",
"end": "2017-05-18T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:d879e0f9-024d-49bd-8bf0-475bb966a44e",
"resource": {
"resourceType": "Observation",
"id": "d879e0f9-024d-49bd-8bf0-475bb966a44e",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height"
}
],
"text": "Body Height"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 172.7,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:9e1663fb-71a9-4bea-948e-b7e9f5cbc900",
"resource": {
"resourceType": "Observation",
"id": "9e1663fb-71a9-4bea-948e-b7e9f5cbc900",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72514-3",
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
}
],
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:b1b716cb-313d-4c62-8b75-ac89887fe877",
"resource": {
"resourceType": "Observation",
"id": "b1b716cb-313d-4c62-8b75-ac89887fe877",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "29463-7",
"display": "Body Weight"
}
],
"text": "Body Weight"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 81.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:194d9af9-57cc-43e8-87a1-cf9bf1fed796",
"resource": {
"resourceType": "Observation",
"id": "194d9af9-57cc-43e8-87a1-cf9bf1fed796",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body Mass Index"
}
],
"text": "Body Mass Index"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.23,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:e0ec2f45-0f6d-4686-83d0-667129bfb3bd",
"resource": {
"resourceType": "Observation",
"id": "e0ec2f45-0f6d-4686-83d0-667129bfb3bd",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "85354-9",
"display": "Blood Pressure"
}
],
"text": "Blood Pressure"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 76,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 108,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:c7329ddb-048e-4eee-8d9b-7184b9609554",
"resource": {
"resourceType": "Observation",
"id": "c7329ddb-048e-4eee-8d9b-7184b9609554",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2339-0",
"display": "Glucose"
}
],
"text": "Glucose"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 86.44,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:3040b6e4-6f39-4266-b24c-e693043991ec",
"resource": {
"resourceType": "Observation",
"id": "3040b6e4-6f39-4266-b24c-e693043991ec",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6299-2",
"display": "Urea Nitrogen"
}
],
"text": "Urea Nitrogen"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 12.02,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:b68ce3eb-0aac-430e-9f45-6fd69f284b67",
"resource": {
"resourceType": "Observation",
"id": "b68ce3eb-0aac-430e-9f45-6fd69f284b67",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "38483-4",
"display": "Creatinine"
}
],
"text": "Creatinine"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 0.76,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:1d4c151e-5970-43c8-93b9-7a05fd700303",
"resource": {
"resourceType": "Observation",
"id": "1d4c151e-5970-43c8-93b9-7a05fd700303",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "49765-1",
"display": "Calcium"
}
],
"text": "Calcium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 9.41,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:4348df44-9392-4609-b825-e90b1ae6729b",
"resource": {
"resourceType": "Observation",
"id": "4348df44-9392-4609-b825-e90b1ae6729b",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2947-0",
"display": "Sodium"
}
],
"text": "Sodium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 137.54,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:220eba4b-392a-42b2-9a5a-d7d9899287a7",
"resource": {
"resourceType": "Observation",
"id": "220eba4b-392a-42b2-9a5a-d7d9899287a7",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6298-4",
"display": "Potassium"
}
],
"text": "Potassium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 4.5,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:434e8e53-1922-4436-a3d9-eac0b0890958",
"resource": {
"resourceType": "Observation",
"id": "434e8e53-1922-4436-a3d9-eac0b0890958",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2069-3",
"display": "Chloride"
}
],
"text": "Chloride"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 107.33,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:f283a6fa-53ee-4e74-8360-09e298390ba0",
"resource": {
"resourceType": "Observation",
"id": "f283a6fa-53ee-4e74-8360-09e298390ba0",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "20565-8",
"display": "Carbon Dioxide"
}
],
"text": "Carbon Dioxide"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 20.36,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:bfa025b8-b3d1-43b6-a3ba-347193b92b48",
"resource": {
"resourceType": "Observation",
"id": "bfa025b8-b3d1-43b6-a3ba-347193b92b48",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72166-2",
"display": "Tobacco smoking status NHIS"
}
],
"text": "Tobacco smoking status NHIS"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Former smoker"
}
],
"text": "Former smoker"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:4a3dc2d4-7c7e-4bbd-9445-0755c5a68548",
"resource": {
"resourceType": "Observation",
"id": "4a3dc2d4-7c7e-4bbd-9445-0755c5a68548",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
}
],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"valueQuantity": {
"value": 6.22,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:041f998b-8773-4bb0-a39a-75b63b5a9201",
"resource": {
"resourceType": "Immunization",
"id": "041f998b-8773-4bb0-a39a-75b63b5a9201",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"occurrenceDateTime": "2017-05-18T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:de7d43d7-565b-42ac-a5b9-145522f95398",
"resource": {
"resourceType": "Immunization",
"id": "de7d43d7-565b-42ac-a5b9-145522f95398",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "113",
"display": "Td (adult) preservative free"
}
],
"text": "Td (adult) preservative free"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"occurrenceDateTime": "2017-05-18T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:74d3dae5-4d87-406d-8531-f248647803c0",
"resource": {
"resourceType": "DiagnosticReport",
"id": "74d3dae5-4d87-406d-8531-f248647803c0",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic Metabolic Panel"
}
],
"text": "Basic Metabolic Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
},
"effectiveDateTime": "2017-05-18T19:34:29+00:00",
"issued": "2017-05-18T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:c7329ddb-048e-4eee-8d9b-7184b9609554",
"display": "Glucose"
},
{
"reference": "urn:uuid:3040b6e4-6f39-4266-b24c-e693043991ec",
"display": "Urea Nitrogen"
},
{
"reference": "urn:uuid:b68ce3eb-0aac-430e-9f45-6fd69f284b67",
"display": "Creatinine"
},
{
"reference": "urn:uuid:1d4c151e-5970-43c8-93b9-7a05fd700303",
"display": "Calcium"
},
{
"reference": "urn:uuid:4348df44-9392-4609-b825-e90b1ae6729b",
"display": "Sodium"
},
{
"reference": "urn:uuid:220eba4b-392a-42b2-9a5a-d7d9899287a7",
"display": "Potassium"
},
{
"reference": "urn:uuid:434e8e53-1922-4436-a3d9-eac0b0890958",
"display": "Chloride"
},
{
"reference": "urn:uuid:f283a6fa-53ee-4e74-8360-09e298390ba0",
"display": "Carbon Dioxide"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:aee2aa0e-e1e9-46e7-81f5-2bb538439e59",
"resource": {
"resourceType": "Claim",
"id": "aee2aa0e-e1e9-46e7-81f5-2bb538439e59",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2017-05-18T19:34:29+00:00",
"end": "2017-05-18T19:49:29+00:00"
},
"created": "2017-05-18T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:041f998b-8773-4bb0-a39a-75b63b5a9201"
}
},
{
"sequence": 2,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:de7d43d7-565b-42ac-a5b9-145522f95398"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 140.52,
"currency": "USD"
}
},
{
"sequence": 3,
"informationSequence": [
2
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "113",
"display": "Td (adult) preservative free"
}
],
"text": "Td (adult) preservative free"
},
"net": {
"value": 140.52,
"currency": "USD"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:f37fa2c5-ea53-4d66-a933-c7742ed6dcd7",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "f37fa2c5-ea53-4d66-a933-c7742ed6dcd7",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Humana"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Humana"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "aee2aa0e-e1e9-46e7-81f5-2bb538439e59"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2017-05-18T19:49:29+00:00",
"end": "2018-05-18T19:49:29+00:00"
},
"created": "2017-05-18T19:49:29+00:00",
"insurer": {
"display": "Humana"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:aee2aa0e-e1e9-46e7-81f5-2bb538439e59"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2017-05-18T19:34:29+00:00",
"end": "2017-05-18T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:3ef62e75-bcf1-4ea8-9566-f22ed69ab6b9"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2017-05-18T19:34:29+00:00",
"end": "2017-05-18T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
},
{
"sequence": 3,
"informationSequence": [
2
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "113",
"display": "Td (adult) preservative free"
}
],
"text": "Td (adult) preservative free"
},
"servicedPeriod": {
"start": "2017-05-18T19:34:29+00:00",
"end": "2017-05-18T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 224.83200000000002,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10",
"resource": {
"resourceType": "Encounter",
"id": "2774946e-8dc3-42a4-9e2a-eb922f31de10",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "2018-05-24T19:34:29+00:00",
"end": "2018-05-24T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:6a790f83-d98f-460b-93c7-92ed3d389389",
"resource": {
"resourceType": "Observation",
"id": "6a790f83-d98f-460b-93c7-92ed3d389389",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height"
}
],
"text": "Body Height"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 172.7,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:04780fb6-449d-4c15-b80a-7e8e1addd3a7",
"resource": {
"resourceType": "Observation",
"id": "04780fb6-449d-4c15-b80a-7e8e1addd3a7",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72514-3",
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
}
],
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:6296e590-49a5-400b-96bd-b49e719c9915",
"resource": {
"resourceType": "Observation",
"id": "6296e590-49a5-400b-96bd-b49e719c9915",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "29463-7",
"display": "Body Weight"
}
],
"text": "Body Weight"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 81.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:8c76ba63-e582-450f-8abc-e083cf5c48e0",
"resource": {
"resourceType": "Observation",
"id": "8c76ba63-e582-450f-8abc-e083cf5c48e0",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body Mass Index"
}
],
"text": "Body Mass Index"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.23,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:3cc13f1e-ee94-4e37-9f56-8a6d844fc63d",
"resource": {
"resourceType": "Observation",
"id": "3cc13f1e-ee94-4e37-9f56-8a6d844fc63d",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "85354-9",
"display": "Blood Pressure"
}
],
"text": "Blood Pressure"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 75,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 121,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:87cfd1b0-db49-45c3-8e62-843a535e0821",
"resource": {
"resourceType": "Observation",
"id": "87cfd1b0-db49-45c3-8e62-843a535e0821",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2339-0",
"display": "Glucose"
}
],
"text": "Glucose"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 81.39,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:cbf1cde7-fcf3-4097-a8e4-eaa18772b017",
"resource": {
"resourceType": "Observation",
"id": "cbf1cde7-fcf3-4097-a8e4-eaa18772b017",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6299-2",
"display": "Urea Nitrogen"
}
],
"text": "Urea Nitrogen"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 8.77,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:acb8ee24-ff42-48c4-8085-4799a55dbc1d",
"resource": {
"resourceType": "Observation",
"id": "acb8ee24-ff42-48c4-8085-4799a55dbc1d",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "38483-4",
"display": "Creatinine"
}
],
"text": "Creatinine"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 0.75,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:bcd07a12-938b-48ff-87d7-5110973746d9",
"resource": {
"resourceType": "Observation",
"id": "bcd07a12-938b-48ff-87d7-5110973746d9",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "49765-1",
"display": "Calcium"
}
],
"text": "Calcium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 8.67,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:132e3aa0-76ee-45e8-acab-77d2274d0cd0",
"resource": {
"resourceType": "Observation",
"id": "132e3aa0-76ee-45e8-acab-77d2274d0cd0",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2947-0",
"display": "Sodium"
}
],
"text": "Sodium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 138.62,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:c248534b-580c-40b6-ac7a-1b8fb7c2579a",
"resource": {
"resourceType": "Observation",
"id": "c248534b-580c-40b6-ac7a-1b8fb7c2579a",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6298-4",
"display": "Potassium"
}
],
"text": "Potassium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 4.04,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:2175cd3e-4532-43e3-b6af-a7f84ecf3869",
"resource": {
"resourceType": "Observation",
"id": "2175cd3e-4532-43e3-b6af-a7f84ecf3869",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2069-3",
"display": "Chloride"
}
],
"text": "Chloride"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 101.34,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:1e915277-ab18-48fa-ae22-ff2624ea833a",
"resource": {
"resourceType": "Observation",
"id": "1e915277-ab18-48fa-ae22-ff2624ea833a",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "20565-8",
"display": "Carbon Dioxide"
}
],
"text": "Carbon Dioxide"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 20.57,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:65df47e1-6739-489c-ac7e-f2a656303614",
"resource": {
"resourceType": "Observation",
"id": "65df47e1-6739-489c-ac7e-f2a656303614",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2093-3",
"display": "Total Cholesterol"
}
],
"text": "Total Cholesterol"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 179.01,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:bdb80870-0ba4-4e04-a33b-9a0c398cb817",
"resource": {
"resourceType": "Observation",
"id": "bdb80870-0ba4-4e04-a33b-9a0c398cb817",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2571-8",
"display": "Triglycerides"
}
],
"text": "Triglycerides"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 114.7,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:b989732f-8ab8-4c25-a3d9-3bc49b788ddf",
"resource": {
"resourceType": "Observation",
"id": "b989732f-8ab8-4c25-a3d9-3bc49b788ddf",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "18262-6",
"display": "Low Density Lipoprotein Cholesterol"
}
],
"text": "Low Density Lipoprotein Cholesterol"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 93.14,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:604aead8-5bb4-41b4-abac-64dc636f8fe7",
"resource": {
"resourceType": "Observation",
"id": "604aead8-5bb4-41b4-abac-64dc636f8fe7",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2085-9",
"display": "High Density Lipoprotein Cholesterol"
}
],
"text": "High Density Lipoprotein Cholesterol"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 62.93,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:13d8a3f5-d35e-4e0b-9e9f-339e295f46b0",
"resource": {
"resourceType": "Observation",
"id": "13d8a3f5-d35e-4e0b-9e9f-339e295f46b0",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6690-2",
"display": "Leukocytes [#/volume] in Blood by Automated count"
}
],
"text": "Leukocytes [#/volume] in Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 7.7858,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:4b3b6d89-c5a4-4d57-b8af-840d9d862b0e",
"resource": {
"resourceType": "Observation",
"id": "4b3b6d89-c5a4-4d57-b8af-840d9d862b0e",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "789-8",
"display": "Erythrocytes [#/volume] in Blood by Automated count"
}
],
"text": "Erythrocytes [#/volume] in Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 4.4656,
"unit": "10*6/uL",
"system": "http://unitsofmeasure.org",
"code": "10*6/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:d841833e-e016-409b-9368-247752d38769",
"resource": {
"resourceType": "Observation",
"id": "d841833e-e016-409b-9368-247752d38769",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "718-7",
"display": "Hemoglobin [Mass/volume] in Blood"
}
],
"text": "Hemoglobin [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 13.806,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:973c7196-0cc5-4649-bcaf-9d5e857dc87a",
"resource": {
"resourceType": "Observation",
"id": "973c7196-0cc5-4649-bcaf-9d5e857dc87a",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4544-3",
"display": "Hematocrit [Volume Fraction] of Blood by Automated count"
}
],
"text": "Hematocrit [Volume Fraction] of Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 39.102,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:241d4b13-f651-4f96-a176-726655af810e",
"resource": {
"resourceType": "Observation",
"id": "241d4b13-f651-4f96-a176-726655af810e",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "787-2",
"display": "MCV [Entitic volume] by Automated count"
}
],
"text": "MCV [Entitic volume] by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 92.211,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:1c018e80-f534-4ed2-a6cc-9c1efbcaacee",
"resource": {
"resourceType": "Observation",
"id": "1c018e80-f534-4ed2-a6cc-9c1efbcaacee",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "785-6",
"display": "MCH [Entitic mass] by Automated count"
}
],
"text": "MCH [Entitic mass] by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 32.436,
"unit": "pg",
"system": "http://unitsofmeasure.org",
"code": "pg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:b2da7ba2-e636-4dc5-afaf-fab3e50fc2ba",
"resource": {
"resourceType": "Observation",
"id": "b2da7ba2-e636-4dc5-afaf-fab3e50fc2ba",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "786-4",
"display": "MCHC [Mass/volume] by Automated count"
}
],
"text": "MCHC [Mass/volume] by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 35.558,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:a36505bf-17ef-486a-88ee-4e4354148c9b",
"resource": {
"resourceType": "Observation",
"id": "a36505bf-17ef-486a-88ee-4e4354148c9b",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "21000-5",
"display": "Erythrocyte distribution width [Entitic volume] by Automated count"
}
],
"text": "Erythrocyte distribution width [Entitic volume] by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 40.643,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:c882bdab-cfdd-4fea-81dd-1247d7edf08b",
"resource": {
"resourceType": "Observation",
"id": "c882bdab-cfdd-4fea-81dd-1247d7edf08b",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "777-3",
"display": "Platelets [#/volume] in Blood by Automated count"
}
],
"text": "Platelets [#/volume] in Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 274.21,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:3ba4e167-7f8d-468b-90a8-d0987b2e3b02",
"resource": {
"resourceType": "Observation",
"id": "3ba4e167-7f8d-468b-90a8-d0987b2e3b02",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "32207-3",
"display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
}
],
"text": "Platelet distribution width [Entitic volume] in Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 340.31,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:50814d86-8944-4049-acb6-632f1cbe82d7",
"resource": {
"resourceType": "Observation",
"id": "50814d86-8944-4049-acb6-632f1cbe82d7",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "32623-1",
"display": "Platelet mean volume [Entitic volume] in Blood by Automated count"
}
],
"text": "Platelet mean volume [Entitic volume] in Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 10.994,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:97407103-757d-4aea-a2ff-cdc1d97aab03",
"resource": {
"resourceType": "Observation",
"id": "97407103-757d-4aea-a2ff-cdc1d97aab03",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72166-2",
"display": "Tobacco smoking status NHIS"
}
],
"text": "Tobacco smoking status NHIS"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Former smoker"
}
],
"text": "Former smoker"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:d5cd53e0-3383-402f-b090-0c4fc2170695",
"resource": {
"resourceType": "Observation",
"id": "d5cd53e0-3383-402f-b090-0c4fc2170695",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
}
],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"valueQuantity": {
"value": 6.35,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:ada71183-45b2-4f9a-adbc-34376f75cf94",
"resource": {
"resourceType": "Immunization",
"id": "ada71183-45b2-4f9a-adbc-34376f75cf94",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"occurrenceDateTime": "2018-05-24T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:e43ae360-15af-4d79-8ba4-1a2b294e608a",
"resource": {
"resourceType": "DiagnosticReport",
"id": "e43ae360-15af-4d79-8ba4-1a2b294e608a",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic Metabolic Panel"
}
],
"text": "Basic Metabolic Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:87cfd1b0-db49-45c3-8e62-843a535e0821",
"display": "Glucose"
},
{
"reference": "urn:uuid:cbf1cde7-fcf3-4097-a8e4-eaa18772b017",
"display": "Urea Nitrogen"
},
{
"reference": "urn:uuid:acb8ee24-ff42-48c4-8085-4799a55dbc1d",
"display": "Creatinine"
},
{
"reference": "urn:uuid:bcd07a12-938b-48ff-87d7-5110973746d9",
"display": "Calcium"
},
{
"reference": "urn:uuid:132e3aa0-76ee-45e8-acab-77d2274d0cd0",
"display": "Sodium"
},
{
"reference": "urn:uuid:c248534b-580c-40b6-ac7a-1b8fb7c2579a",
"display": "Potassium"
},
{
"reference": "urn:uuid:2175cd3e-4532-43e3-b6af-a7f84ecf3869",
"display": "Chloride"
},
{
"reference": "urn:uuid:1e915277-ab18-48fa-ae22-ff2624ea833a",
"display": "Carbon Dioxide"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:8af3e1ad-5f2c-4b5c-b6dd-880e1d003bd6",
"resource": {
"resourceType": "DiagnosticReport",
"id": "8af3e1ad-5f2c-4b5c-b6dd-880e1d003bd6",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "57698-3",
"display": "Lipid Panel"
}
],
"text": "Lipid Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:65df47e1-6739-489c-ac7e-f2a656303614",
"display": "Total Cholesterol"
},
{
"reference": "urn:uuid:bdb80870-0ba4-4e04-a33b-9a0c398cb817",
"display": "Triglycerides"
},
{
"reference": "urn:uuid:b989732f-8ab8-4c25-a3d9-3bc49b788ddf",
"display": "Low Density Lipoprotein Cholesterol"
},
{
"reference": "urn:uuid:604aead8-5bb4-41b4-abac-64dc636f8fe7",
"display": "High Density Lipoprotein Cholesterol"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:8937e0f4-2338-4a64-8223-8cc8cf5f28a3",
"resource": {
"resourceType": "DiagnosticReport",
"id": "8937e0f4-2338-4a64-8223-8cc8cf5f28a3",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "58410-2",
"display": "Complete blood count (hemogram) panel - Blood by Automated count"
}
],
"text": "Complete blood count (hemogram) panel - Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
},
"effectiveDateTime": "2018-05-24T19:34:29+00:00",
"issued": "2018-05-24T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:13d8a3f5-d35e-4e0b-9e9f-339e295f46b0",
"display": "Leukocytes [#/volume] in Blood by Automated count"
},
{
"reference": "urn:uuid:4b3b6d89-c5a4-4d57-b8af-840d9d862b0e",
"display": "Erythrocytes [#/volume] in Blood by Automated count"
},
{
"reference": "urn:uuid:d841833e-e016-409b-9368-247752d38769",
"display": "Hemoglobin [Mass/volume] in Blood"
},
{
"reference": "urn:uuid:973c7196-0cc5-4649-bcaf-9d5e857dc87a",
"display": "Hematocrit [Volume Fraction] of Blood by Automated count"
},
{
"reference": "urn:uuid:241d4b13-f651-4f96-a176-726655af810e",
"display": "MCV [Entitic volume] by Automated count"
},
{
"reference": "urn:uuid:1c018e80-f534-4ed2-a6cc-9c1efbcaacee",
"display": "MCH [Entitic mass] by Automated count"
},
{
"reference": "urn:uuid:b2da7ba2-e636-4dc5-afaf-fab3e50fc2ba",
"display": "MCHC [Mass/volume] by Automated count"
},
{
"reference": "urn:uuid:a36505bf-17ef-486a-88ee-4e4354148c9b",
"display": "Erythrocyte distribution width [Entitic volume] by Automated count"
},
{
"reference": "urn:uuid:c882bdab-cfdd-4fea-81dd-1247d7edf08b",
"display": "Platelets [#/volume] in Blood by Automated count"
},
{
"reference": "urn:uuid:3ba4e167-7f8d-468b-90a8-d0987b2e3b02",
"display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
},
{
"reference": "urn:uuid:50814d86-8944-4049-acb6-632f1cbe82d7",
"display": "Platelet mean volume [Entitic volume] in Blood by Automated count"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:cc87a132-5a4d-4a88-9f96-e2f0d872b31d",
"resource": {
"resourceType": "Claim",
"id": "cc87a132-5a4d-4a88-9f96-e2f0d872b31d",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2018-05-24T19:34:29+00:00",
"end": "2018-05-24T19:49:29+00:00"
},
"created": "2018-05-24T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:ada71183-45b2-4f9a-adbc-34376f75cf94"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 140.52,
"currency": "USD"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:4a586fae-045f-4679-96f8-8dc6231e433f",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "4a586fae-045f-4679-96f8-8dc6231e433f",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Humana"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Humana"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "cc87a132-5a4d-4a88-9f96-e2f0d872b31d"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2018-05-24T19:49:29+00:00",
"end": "2019-05-24T19:49:29+00:00"
},
"created": "2018-05-24T19:49:29+00:00",
"insurer": {
"display": "Humana"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:cc87a132-5a4d-4a88-9f96-e2f0d872b31d"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2018-05-24T19:34:29+00:00",
"end": "2018-05-24T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:2774946e-8dc3-42a4-9e2a-eb922f31de10"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2018-05-24T19:34:29+00:00",
"end": "2018-05-24T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:24cb4eab-6166-3530-bddc-a5a8a14a4fc1",
"resource": {
"resourceType": "Organization",
"id": "24cb4eab-6166-3530-bddc-a5a8a14a4fc1",
"identifier": [
{
"system": "https://github.com/synthetichealth/synthea",
"value": "24cb4eab-6166-3530-bddc-a5a8a14a4fc1"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "prov",
"display": "Healthcare Provider"
}
],
"text": "Healthcare Provider"
}
],
"name": "MILFORD REGIONAL MEDICAL CENTER",
"telecom": [
{
"system": "phone",
"value": "5084731190"
}
],
"address": [
{
"line": [
"14 PROSPECT STREET"
],
"city": "MILFORD",
"state": "MA",
"postalCode": "01757",
"country": "US"
}
]
},
"request": {
"method": "POST",
"url": "Organization"
}
},
{
"fullUrl": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c",
"resource": {
"resourceType": "Practitioner",
"id": "00000199-be0b-2ec3-0000-00000000017c",
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "380"
}
],
"active": true,
"name": [
{
"family": "Hartmann983",
"given": [
"Yael855"
],
"prefix": [
"Dr."
]
}
],
"telecom": [
{
"system": "email",
"value": "Yael855.Hartmann983@example.com",
"use": "work"
}
],
"address": [
{
"line": [
"14 PROSPECT STREET"
],
"city": "MILFORD",
"state": "MA",
"postalCode": "01757",
"country": "US"
}
],
"gender": "female"
},
"request": {
"method": "POST",
"url": "Practitioner"
}
},
{
"fullUrl": "urn:uuid:b555ec76-f11d-4c13-b609-c7ca26dab469",
"resource": {
"resourceType": "Encounter",
"id": "b555ec76-f11d-4c13-b609-c7ca26dab469",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c",
"display": "Dr. Yael855 Hartmann983"
}
}
],
"period": {
"start": "2018-12-29T19:34:29+00:00",
"end": "2018-12-29T19:49:29+00:00"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
}
]
}
],
"serviceProvider": {
"reference": "urn:uuid:24cb4eab-6166-3530-bddc-a5a8a14a4fc1",
"display": "MILFORD REGIONAL MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:3cf9a135-b435-4ce1-941f-8fc749c15a66",
"resource": {
"resourceType": "Condition",
"id": "3cf9a135-b435-4ce1-941f-8fc749c15a66",
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
}
],
"text": "Acute viral pharyngitis (disorder)"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:b555ec76-f11d-4c13-b609-c7ca26dab469"
},
"onsetDateTime": "2018-12-29T19:34:29+00:00",
"abatementDateTime": "2019-01-06T19:34:29+00:00",
"recordedDate": "2018-12-29T19:34:29+00:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "urn:uuid:f6900447-a6ea-436f-9738-c884df4cd4eb",
"resource": {
"resourceType": "Observation",
"id": "f6900447-a6ea-436f-9738-c884df4cd4eb",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8331-1",
"display": "Oral temperature"
}
],
"text": "Oral temperature"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:b555ec76-f11d-4c13-b609-c7ca26dab469"
},
"effectiveDateTime": "2018-12-29T19:34:29+00:00",
"issued": "2018-12-29T19:34:29.095+00:00",
"valueQuantity": {
"value": 37.233,
"unit": "Cel",
"system": "http://unitsofmeasure.org",
"code": "Cel"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:14725f09-5f76-4bea-b55e-fbeaf81d2405",
"resource": {
"resourceType": "Claim",
"id": "14725f09-5f76-4bea-b55e-fbeaf81d2405",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2018-12-29T19:34:29+00:00",
"end": "2018-12-29T19:49:29+00:00"
},
"created": "2018-12-29T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:24cb4eab-6166-3530-bddc-a5a8a14a4fc1",
"display": "MILFORD REGIONAL MEDICAL CENTER"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:3cf9a135-b435-4ce1-941f-8fc749c15a66"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
},
"encounter": [
{
"reference": "urn:uuid:b555ec76-f11d-4c13-b609-c7ca26dab469"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
}
],
"text": "Acute viral pharyngitis (disorder)"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:a77c4208-9b18-46fa-b66b-491c1b760d78",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "a77c4208-9b18-46fa-b66b-491c1b760d78",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Humana"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Humana"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "14725f09-5f76-4bea-b55e-fbeaf81d2405"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2018-12-29T19:49:29+00:00",
"end": "2019-12-29T19:49:29+00:00"
},
"created": "2018-12-29T19:49:29+00:00",
"insurer": {
"display": "Humana"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:14725f09-5f76-4bea-b55e-fbeaf81d2405"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:3cf9a135-b435-4ce1-941f-8fc749c15a66"
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
}
]
}
]
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
},
"servicedPeriod": {
"start": "2018-12-29T19:34:29+00:00",
"end": "2018-12-29T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:b555ec76-f11d-4c13-b609-c7ca26dab469"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
}
],
"text": "Acute viral pharyngitis (disorder)"
},
"servicedPeriod": {
"start": "2018-12-29T19:34:29+00:00",
"end": "2018-12-29T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
}
]
}
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab",
"resource": {
"resourceType": "Encounter",
"id": "fff8f1f4-05ef-489e-b49d-2f4192ab22ab",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "2019-05-30T19:34:29+00:00",
"end": "2019-05-30T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:ea66ac13-bd89-4cb0-b1f9-9a05f2e0f5dc",
"resource": {
"resourceType": "Observation",
"id": "ea66ac13-bd89-4cb0-b1f9-9a05f2e0f5dc",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height"
}
],
"text": "Body Height"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 172.7,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:50d30947-80f1-46eb-a3ba-aa39d5ca5db8",
"resource": {
"resourceType": "Observation",
"id": "50d30947-80f1-46eb-a3ba-aa39d5ca5db8",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72514-3",
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
}
],
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 3,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:8c1152d0-a926-41ee-9607-810ac266c9fd",
"resource": {
"resourceType": "Observation",
"id": "8c1152d0-a926-41ee-9607-810ac266c9fd",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "29463-7",
"display": "Body Weight"
}
],
"text": "Body Weight"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 81.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:ad99c808-f035-48f0-abc2-ebce8c0ba725",
"resource": {
"resourceType": "Observation",
"id": "ad99c808-f035-48f0-abc2-ebce8c0ba725",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body Mass Index"
}
],
"text": "Body Mass Index"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.23,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:06cacb60-1e91-499c-85ed-56e6d4f37750",
"resource": {
"resourceType": "Observation",
"id": "06cacb60-1e91-499c-85ed-56e6d4f37750",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "85354-9",
"display": "Blood Pressure"
}
],
"text": "Blood Pressure"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 87,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 120.0,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:c192eea4-1f3c-4cf7-b06b-6638a42fd1e4",
"resource": {
"resourceType": "Observation",
"id": "c192eea4-1f3c-4cf7-b06b-6638a42fd1e4",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2339-0",
"display": "Glucose"
}
],
"text": "Glucose"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 79.33,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:7bebe879-bd26-4e6b-b3b7-38ecb00801f9",
"resource": {
"resourceType": "Observation",
"id": "7bebe879-bd26-4e6b-b3b7-38ecb00801f9",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6299-2",
"display": "Urea Nitrogen"
}
],
"text": "Urea Nitrogen"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 13.06,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:5420a670-decf-4824-adb8-3183ed0c6315",
"resource": {
"resourceType": "Observation",
"id": "5420a670-decf-4824-adb8-3183ed0c6315",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "38483-4",
"display": "Creatinine"
}
],
"text": "Creatinine"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 0.74,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:8d6f93bf-96dd-4237-bade-c9e96c04826e",
"resource": {
"resourceType": "Observation",
"id": "8d6f93bf-96dd-4237-bade-c9e96c04826e",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "49765-1",
"display": "Calcium"
}
],
"text": "Calcium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 9.4,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:af05a725-fbc9-464c-9265-cd0cb91a0236",
"resource": {
"resourceType": "Observation",
"id": "af05a725-fbc9-464c-9265-cd0cb91a0236",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2947-0",
"display": "Sodium"
}
],
"text": "Sodium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 139.89,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:3b2df42a-d61a-43d5-9e4d-ca5cdac98e5f",
"resource": {
"resourceType": "Observation",
"id": "3b2df42a-d61a-43d5-9e4d-ca5cdac98e5f",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6298-4",
"display": "Potassium"
}
],
"text": "Potassium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 4.25,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:436c01d7-a211-4ea8-8555-124c52c30b1e",
"resource": {
"resourceType": "Observation",
"id": "436c01d7-a211-4ea8-8555-124c52c30b1e",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2069-3",
"display": "Chloride"
}
],
"text": "Chloride"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 106.4,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:6dd137d7-1d27-41df-b5c8-b8ab684d3d90",
"resource": {
"resourceType": "Observation",
"id": "6dd137d7-1d27-41df-b5c8-b8ab684d3d90",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "20565-8",
"display": "Carbon Dioxide"
}
],
"text": "Carbon Dioxide"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 25.49,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:21c2d04f-c908-40f4-821a-fa61ae5b055e",
"resource": {
"resourceType": "Observation",
"id": "21c2d04f-c908-40f4-821a-fa61ae5b055e",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72166-2",
"display": "Tobacco smoking status NHIS"
}
],
"text": "Tobacco smoking status NHIS"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Former smoker"
}
],
"text": "Former smoker"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:2cdcedf5-2a6d-4289-829f-e502b9d3bea8",
"resource": {
"resourceType": "Observation",
"id": "2cdcedf5-2a6d-4289-829f-e502b9d3bea8",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
}
],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"valueQuantity": {
"value": 6.31,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:e5485309-16b1-4d5b-b1ec-bf59a7584418",
"resource": {
"resourceType": "Immunization",
"id": "e5485309-16b1-4d5b-b1ec-bf59a7584418",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"occurrenceDateTime": "2019-05-30T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:ae2fc982-2095-4138-b472-2b6f46be5a87",
"resource": {
"resourceType": "DiagnosticReport",
"id": "ae2fc982-2095-4138-b472-2b6f46be5a87",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic Metabolic Panel"
}
],
"text": "Basic Metabolic Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
},
"effectiveDateTime": "2019-05-30T19:34:29+00:00",
"issued": "2019-05-30T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:c192eea4-1f3c-4cf7-b06b-6638a42fd1e4",
"display": "Glucose"
},
{
"reference": "urn:uuid:7bebe879-bd26-4e6b-b3b7-38ecb00801f9",
"display": "Urea Nitrogen"
},
{
"reference": "urn:uuid:5420a670-decf-4824-adb8-3183ed0c6315",
"display": "Creatinine"
},
{
"reference": "urn:uuid:8d6f93bf-96dd-4237-bade-c9e96c04826e",
"display": "Calcium"
},
{
"reference": "urn:uuid:af05a725-fbc9-464c-9265-cd0cb91a0236",
"display": "Sodium"
},
{
"reference": "urn:uuid:3b2df42a-d61a-43d5-9e4d-ca5cdac98e5f",
"display": "Potassium"
},
{
"reference": "urn:uuid:436c01d7-a211-4ea8-8555-124c52c30b1e",
"display": "Chloride"
},
{
"reference": "urn:uuid:6dd137d7-1d27-41df-b5c8-b8ab684d3d90",
"display": "Carbon Dioxide"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:f570d210-55fe-4db5-b6e2-89154172b933",
"resource": {
"resourceType": "Claim",
"id": "f570d210-55fe-4db5-b6e2-89154172b933",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2019-05-30T19:34:29+00:00",
"end": "2019-05-30T19:49:29+00:00"
},
"created": "2019-05-30T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:e5485309-16b1-4d5b-b1ec-bf59a7584418"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 140.52,
"currency": "USD"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:51c000bd-f547-4344-90b3-e1c40ac9adbd",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "51c000bd-f547-4344-90b3-e1c40ac9adbd",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Humana"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Humana"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "f570d210-55fe-4db5-b6e2-89154172b933"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2019-05-30T19:49:29+00:00",
"end": "2020-05-30T19:49:29+00:00"
},
"created": "2019-05-30T19:49:29+00:00",
"insurer": {
"display": "Humana"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:f570d210-55fe-4db5-b6e2-89154172b933"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2019-05-30T19:34:29+00:00",
"end": "2019-05-30T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:fff8f1f4-05ef-489e-b49d-2f4192ab22ab"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2019-05-30T19:34:29+00:00",
"end": "2019-05-30T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81",
"resource": {
"resourceType": "Encounter",
"id": "abdb6c50-44e8-422c-956c-36b8d38eed81",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "2020-06-04T19:34:29+00:00",
"end": "2020-06-04T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:d543f39d-869f-4b70-b8d0-8a9724af71bd",
"resource": {
"resourceType": "Observation",
"id": "d543f39d-869f-4b70-b8d0-8a9724af71bd",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height"
}
],
"text": "Body Height"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 172.7,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:0f37a16a-fb54-47ed-8013-d7eb94a5fae4",
"resource": {
"resourceType": "Observation",
"id": "0f37a16a-fb54-47ed-8013-d7eb94a5fae4",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72514-3",
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
}
],
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 4,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:31752156-fa96-4414-b614-b51074947d3e",
"resource": {
"resourceType": "Observation",
"id": "31752156-fa96-4414-b614-b51074947d3e",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "29463-7",
"display": "Body Weight"
}
],
"text": "Body Weight"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 81.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:ca59cc72-284a-4555-8d57-15569d71cace",
"resource": {
"resourceType": "Observation",
"id": "ca59cc72-284a-4555-8d57-15569d71cace",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body Mass Index"
}
],
"text": "Body Mass Index"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.23,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:75f7f4d8-3619-4606-8b13-4f54daa362d0",
"resource": {
"resourceType": "Observation",
"id": "75f7f4d8-3619-4606-8b13-4f54daa362d0",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "85354-9",
"display": "Blood Pressure"
}
],
"text": "Blood Pressure"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 81,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 105,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:58021cde-2fcc-490f-9428-3d8e4bc3fb77",
"resource": {
"resourceType": "Observation",
"id": "58021cde-2fcc-490f-9428-3d8e4bc3fb77",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2339-0",
"display": "Glucose"
}
],
"text": "Glucose"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 75.47,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:1eb94df7-274a-416b-90c2-9136266d1976",
"resource": {
"resourceType": "Observation",
"id": "1eb94df7-274a-416b-90c2-9136266d1976",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6299-2",
"display": "Urea Nitrogen"
}
],
"text": "Urea Nitrogen"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 8.53,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:43d13ce9-3bfa-4d87-86d4-a6cda911266f",
"resource": {
"resourceType": "Observation",
"id": "43d13ce9-3bfa-4d87-86d4-a6cda911266f",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "38483-4",
"display": "Creatinine"
}
],
"text": "Creatinine"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 0.97,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:aee87e3f-56e8-4864-9bfd-ec4caacefb36",
"resource": {
"resourceType": "Observation",
"id": "aee87e3f-56e8-4864-9bfd-ec4caacefb36",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "49765-1",
"display": "Calcium"
}
],
"text": "Calcium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 9.63,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:bca6db9d-4329-4577-a64f-4d27583fb590",
"resource": {
"resourceType": "Observation",
"id": "bca6db9d-4329-4577-a64f-4d27583fb590",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2947-0",
"display": "Sodium"
}
],
"text": "Sodium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 139.35,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:72e0c7f6-9e44-423c-a2b3-07b8a7f54a0c",
"resource": {
"resourceType": "Observation",
"id": "72e0c7f6-9e44-423c-a2b3-07b8a7f54a0c",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6298-4",
"display": "Potassium"
}
],
"text": "Potassium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 3.86,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:d0124ccd-2d8d-4f56-b515-8af35c619493",
"resource": {
"resourceType": "Observation",
"id": "d0124ccd-2d8d-4f56-b515-8af35c619493",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2069-3",
"display": "Chloride"
}
],
"text": "Chloride"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 102.56,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:37f51b1b-4474-4b45-b1c0-623ceb2f4454",
"resource": {
"resourceType": "Observation",
"id": "37f51b1b-4474-4b45-b1c0-623ceb2f4454",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "20565-8",
"display": "Carbon Dioxide"
}
],
"text": "Carbon Dioxide"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.78,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:2d1cfeb7-e991-49a3-9a0b-3e97dfc1be74",
"resource": {
"resourceType": "Observation",
"id": "2d1cfeb7-e991-49a3-9a0b-3e97dfc1be74",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72166-2",
"display": "Tobacco smoking status NHIS"
}
],
"text": "Tobacco smoking status NHIS"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Former smoker"
}
],
"text": "Former smoker"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:2a755700-12ab-4669-9ad6-16a059b41832",
"resource": {
"resourceType": "Observation",
"id": "2a755700-12ab-4669-9ad6-16a059b41832",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
}
],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"valueQuantity": {
"value": 5.9,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:68c53b78-ce25-41b3-b913-a034964c23c0",
"resource": {
"resourceType": "Immunization",
"id": "68c53b78-ce25-41b3-b913-a034964c23c0",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"occurrenceDateTime": "2020-06-04T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:d0c4db45-eacb-4ff0-aaee-ba36fb66eb5a",
"resource": {
"resourceType": "DiagnosticReport",
"id": "d0c4db45-eacb-4ff0-aaee-ba36fb66eb5a",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic Metabolic Panel"
}
],
"text": "Basic Metabolic Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
},
"effectiveDateTime": "2020-06-04T19:34:29+00:00",
"issued": "2020-06-04T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:58021cde-2fcc-490f-9428-3d8e4bc3fb77",
"display": "Glucose"
},
{
"reference": "urn:uuid:1eb94df7-274a-416b-90c2-9136266d1976",
"display": "Urea Nitrogen"
},
{
"reference": "urn:uuid:43d13ce9-3bfa-4d87-86d4-a6cda911266f",
"display": "Creatinine"
},
{
"reference": "urn:uuid:aee87e3f-56e8-4864-9bfd-ec4caacefb36",
"display": "Calcium"
},
{
"reference": "urn:uuid:bca6db9d-4329-4577-a64f-4d27583fb590",
"display": "Sodium"
},
{
"reference": "urn:uuid:72e0c7f6-9e44-423c-a2b3-07b8a7f54a0c",
"display": "Potassium"
},
{
"reference": "urn:uuid:d0124ccd-2d8d-4f56-b515-8af35c619493",
"display": "Chloride"
},
{
"reference": "urn:uuid:37f51b1b-4474-4b45-b1c0-623ceb2f4454",
"display": "Carbon Dioxide"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:6763a35b-03f9-4178-8415-fb6b469ad5bb",
"resource": {
"resourceType": "Claim",
"id": "6763a35b-03f9-4178-8415-fb6b469ad5bb",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2020-06-04T19:34:29+00:00",
"end": "2020-06-04T19:49:29+00:00"
},
"created": "2020-06-04T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:68c53b78-ce25-41b3-b913-a034964c23c0"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 140.52,
"currency": "USD"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:7157ed20-2eda-4e4d-842b-66c6674f9e7a",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "7157ed20-2eda-4e4d-842b-66c6674f9e7a",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Humana"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Humana"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "6763a35b-03f9-4178-8415-fb6b469ad5bb"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2020-06-04T19:49:29+00:00",
"end": "2021-06-04T19:49:29+00:00"
},
"created": "2020-06-04T19:49:29+00:00",
"insurer": {
"display": "Humana"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:6763a35b-03f9-4178-8415-fb6b469ad5bb"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Humana"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2020-06-04T19:34:29+00:00",
"end": "2020-06-04T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:abdb6c50-44e8-422c-956c-36b8d38eed81"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2020-06-04T19:34:29+00:00",
"end": "2020-06-04T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:b3fb6a54-0ac1-40d5-8d34-a58925a91604",
"resource": {
"resourceType": "Encounter",
"id": "b3fb6a54-0ac1-40d5-8d34-a58925a91604",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c",
"display": "Dr. Yael855 Hartmann983"
}
}
],
"period": {
"start": "2021-03-28T19:34:29+00:00",
"end": "2021-03-28T19:49:29+00:00"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "43878008",
"display": "Streptococcal sore throat (disorder)"
}
]
}
],
"serviceProvider": {
"reference": "urn:uuid:24cb4eab-6166-3530-bddc-a5a8a14a4fc1",
"display": "MILFORD REGIONAL MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:f1cf9ca4-228d-45d3-8149-f0beb5d0cdc3",
"resource": {
"resourceType": "Condition",
"id": "f1cf9ca4-228d-45d3-8149-f0beb5d0cdc3",
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "43878008",
"display": "Streptococcal sore throat (disorder)"
}
],
"text": "Streptococcal sore throat (disorder)"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:b3fb6a54-0ac1-40d5-8d34-a58925a91604"
},
"onsetDateTime": "2021-03-28T19:34:29+00:00",
"abatementDateTime": "2021-04-04T19:34:29+00:00",
"recordedDate": "2021-03-28T19:34:29+00:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "urn:uuid:1fc024fe-7207-407c-9a85-24d3d9147e43",
"resource": {
"resourceType": "Observation",
"id": "1fc024fe-7207-407c-9a85-24d3d9147e43",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8331-1",
"display": "Oral temperature"
}
],
"text": "Oral temperature"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:b3fb6a54-0ac1-40d5-8d34-a58925a91604"
},
"effectiveDateTime": "2021-03-28T19:34:29+00:00",
"issued": "2021-03-28T19:34:29.095+00:00",
"valueQuantity": {
"value": 37.338,
"unit": "Cel",
"system": "http://unitsofmeasure.org",
"code": "Cel"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:60ba9871-abd8-4dc8-a82d-9bb5343b2af7",
"resource": {
"resourceType": "Claim",
"id": "60ba9871-abd8-4dc8-a82d-9bb5343b2af7",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2021-03-28T19:34:29+00:00",
"end": "2021-03-28T19:49:29+00:00"
},
"created": "2021-03-28T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:24cb4eab-6166-3530-bddc-a5a8a14a4fc1",
"display": "MILFORD REGIONAL MEDICAL CENTER"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:f1cf9ca4-228d-45d3-8149-f0beb5d0cdc3"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
},
"encounter": [
{
"reference": "urn:uuid:b3fb6a54-0ac1-40d5-8d34-a58925a91604"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "43878008",
"display": "Streptococcal sore throat (disorder)"
}
],
"text": "Streptococcal sore throat (disorder)"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:30d75f52-8e38-4d1b-872a-b3e41788bfee",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "30d75f52-8e38-4d1b-872a-b3e41788bfee",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicare"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Medicare"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "60ba9871-abd8-4dc8-a82d-9bb5343b2af7"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2021-03-28T19:49:29+00:00",
"end": "2022-03-28T19:49:29+00:00"
},
"created": "2021-03-28T19:49:29+00:00",
"insurer": {
"display": "Medicare"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:60ba9871-abd8-4dc8-a82d-9bb5343b2af7"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:f1cf9ca4-228d-45d3-8149-f0beb5d0cdc3"
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
}
]
}
]
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
},
"servicedPeriod": {
"start": "2021-03-28T19:34:29+00:00",
"end": "2021-03-28T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:b3fb6a54-0ac1-40d5-8d34-a58925a91604"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "43878008",
"display": "Streptococcal sore throat (disorder)"
}
],
"text": "Streptococcal sore throat (disorder)"
},
"servicedPeriod": {
"start": "2021-03-28T19:34:29+00:00",
"end": "2021-03-28T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
}
]
}
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740",
"resource": {
"resourceType": "Encounter",
"id": "d04faa78-626c-4b89-ab16-9c5d51713740",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "2021-06-10T19:34:29+00:00",
"end": "2021-06-10T20:04:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:ae0a5bdf-00c4-4871-adf2-49d8841e5110",
"resource": {
"resourceType": "Observation",
"id": "ae0a5bdf-00c4-4871-adf2-49d8841e5110",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height"
}
],
"text": "Body Height"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 172.7,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:c3063816-fbde-4024-8154-3545d0430aba",
"resource": {
"resourceType": "Observation",
"id": "c3063816-fbde-4024-8154-3545d0430aba",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72514-3",
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
}
],
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:8d50fffd-8fc5-4c03-a24f-87213d7f15d2",
"resource": {
"resourceType": "Observation",
"id": "8d50fffd-8fc5-4c03-a24f-87213d7f15d2",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "29463-7",
"display": "Body Weight"
}
],
"text": "Body Weight"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 81.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:294edf20-8e6e-45ee-b37f-f9be0dd4f108",
"resource": {
"resourceType": "Observation",
"id": "294edf20-8e6e-45ee-b37f-f9be0dd4f108",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body Mass Index"
}
],
"text": "Body Mass Index"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.23,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:fb9881d9-1c41-43bb-ac08-f5e028c533b5",
"resource": {
"resourceType": "Observation",
"id": "fb9881d9-1c41-43bb-ac08-f5e028c533b5",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "85354-9",
"display": "Blood Pressure"
}
],
"text": "Blood Pressure"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 74,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 122,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:33ea7df4-e489-4004-83fd-746cf181e0e9",
"resource": {
"resourceType": "Observation",
"id": "33ea7df4-e489-4004-83fd-746cf181e0e9",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2339-0",
"display": "Glucose"
}
],
"text": "Glucose"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 90.36,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:21626429-66b1-40dc-a753-de13851637c2",
"resource": {
"resourceType": "Observation",
"id": "21626429-66b1-40dc-a753-de13851637c2",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6299-2",
"display": "Urea Nitrogen"
}
],
"text": "Urea Nitrogen"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 12.81,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:4086e8f0-7820-4a42-ac08-da06b2f723da",
"resource": {
"resourceType": "Observation",
"id": "4086e8f0-7820-4a42-ac08-da06b2f723da",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "38483-4",
"display": "Creatinine"
}
],
"text": "Creatinine"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 0.78,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:1f1054aa-ac6a-4056-a597-c3d98e83ef8e",
"resource": {
"resourceType": "Observation",
"id": "1f1054aa-ac6a-4056-a597-c3d98e83ef8e",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "49765-1",
"display": "Calcium"
}
],
"text": "Calcium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 9.78,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:3caaa8a6-5f6c-4fb8-bbea-8bc2219c52d4",
"resource": {
"resourceType": "Observation",
"id": "3caaa8a6-5f6c-4fb8-bbea-8bc2219c52d4",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2947-0",
"display": "Sodium"
}
],
"text": "Sodium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 140.88,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:b631b5b6-fa07-4276-9ab9-0841eb77f1cc",
"resource": {
"resourceType": "Observation",
"id": "b631b5b6-fa07-4276-9ab9-0841eb77f1cc",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6298-4",
"display": "Potassium"
}
],
"text": "Potassium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 4.19,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:8537ca5f-123f-4176-a65a-de63f97f50f3",
"resource": {
"resourceType": "Observation",
"id": "8537ca5f-123f-4176-a65a-de63f97f50f3",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2069-3",
"display": "Chloride"
}
],
"text": "Chloride"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 101.97,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:5f44824b-4810-43d7-9fd4-7c89ae409a3a",
"resource": {
"resourceType": "Observation",
"id": "5f44824b-4810-43d7-9fd4-7c89ae409a3a",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "20565-8",
"display": "Carbon Dioxide"
}
],
"text": "Carbon Dioxide"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 23,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:1b2bf5fc-1d90-474b-bf05-f193798de886",
"resource": {
"resourceType": "Observation",
"id": "1b2bf5fc-1d90-474b-bf05-f193798de886",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2093-3",
"display": "Total Cholesterol"
}
],
"text": "Total Cholesterol"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 164.95,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:e948aea1-9a23-4cd1-a136-929bdb167913",
"resource": {
"resourceType": "Observation",
"id": "e948aea1-9a23-4cd1-a136-929bdb167913",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2571-8",
"display": "Triglycerides"
}
],
"text": "Triglycerides"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 139.65,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:11613f8b-2e50-49e2-9b32-e084f7e48417",
"resource": {
"resourceType": "Observation",
"id": "11613f8b-2e50-49e2-9b32-e084f7e48417",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "18262-6",
"display": "Low Density Lipoprotein Cholesterol"
}
],
"text": "Low Density Lipoprotein Cholesterol"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 64.63,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:ed567495-c2b6-45f2-a9ff-183cc642ca4e",
"resource": {
"resourceType": "Observation",
"id": "ed567495-c2b6-45f2-a9ff-183cc642ca4e",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2085-9",
"display": "High Density Lipoprotein Cholesterol"
}
],
"text": "High Density Lipoprotein Cholesterol"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 72.39,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:39635493-d310-4790-9fa1-29d132277ffb",
"resource": {
"resourceType": "Observation",
"id": "39635493-d310-4790-9fa1-29d132277ffb",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72166-2",
"display": "Tobacco smoking status NHIS"
}
],
"text": "Tobacco smoking status NHIS"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Former smoker"
}
],
"text": "Former smoker"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:a627228b-fdb0-4825-a67a-bee7e179797d",
"resource": {
"resourceType": "Observation",
"id": "a627228b-fdb0-4825-a67a-bee7e179797d",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
}
],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"valueQuantity": {
"value": 6.14,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:37e5857a-4622-407a-8475-f0befc132b9f",
"resource": {
"resourceType": "Procedure",
"id": "37e5857a-4622-407a-8475-f0befc132b9f",
"status": "completed",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
}
],
"text": "Medication Reconciliation (procedure)"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"performedPeriod": {
"start": "2021-06-10T19:34:29+00:00",
"end": "2021-06-10T19:49:29+00:00"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
},
{
"fullUrl": "urn:uuid:28ec8f85-d8d3-4422-82f4-94ea3542c859",
"resource": {
"resourceType": "Immunization",
"id": "28ec8f85-d8d3-4422-82f4-94ea3542c859",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"occurrenceDateTime": "2021-06-10T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:3821ba97-cd29-4d4a-990b-86b04d084e50",
"resource": {
"resourceType": "Immunization",
"id": "3821ba97-cd29-4d4a-990b-86b04d084e50",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "133",
"display": "Pneumococcal conjugate PCV 13"
}
],
"text": "Pneumococcal conjugate PCV 13"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"occurrenceDateTime": "2021-06-10T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:04d4bebc-89a1-4516-8bcd-c134cde3d795",
"resource": {
"resourceType": "DiagnosticReport",
"id": "04d4bebc-89a1-4516-8bcd-c134cde3d795",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic Metabolic Panel"
}
],
"text": "Basic Metabolic Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:33ea7df4-e489-4004-83fd-746cf181e0e9",
"display": "Glucose"
},
{
"reference": "urn:uuid:21626429-66b1-40dc-a753-de13851637c2",
"display": "Urea Nitrogen"
},
{
"reference": "urn:uuid:4086e8f0-7820-4a42-ac08-da06b2f723da",
"display": "Creatinine"
},
{
"reference": "urn:uuid:1f1054aa-ac6a-4056-a597-c3d98e83ef8e",
"display": "Calcium"
},
{
"reference": "urn:uuid:3caaa8a6-5f6c-4fb8-bbea-8bc2219c52d4",
"display": "Sodium"
},
{
"reference": "urn:uuid:b631b5b6-fa07-4276-9ab9-0841eb77f1cc",
"display": "Potassium"
},
{
"reference": "urn:uuid:8537ca5f-123f-4176-a65a-de63f97f50f3",
"display": "Chloride"
},
{
"reference": "urn:uuid:5f44824b-4810-43d7-9fd4-7c89ae409a3a",
"display": "Carbon Dioxide"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:c0c7857b-cee5-4aac-83ca-361fb6b41bc5",
"resource": {
"resourceType": "DiagnosticReport",
"id": "c0c7857b-cee5-4aac-83ca-361fb6b41bc5",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "57698-3",
"display": "Lipid Panel"
}
],
"text": "Lipid Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
},
"effectiveDateTime": "2021-06-10T19:34:29+00:00",
"issued": "2021-06-10T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:1b2bf5fc-1d90-474b-bf05-f193798de886",
"display": "Total Cholesterol"
},
{
"reference": "urn:uuid:e948aea1-9a23-4cd1-a136-929bdb167913",
"display": "Triglycerides"
},
{
"reference": "urn:uuid:11613f8b-2e50-49e2-9b32-e084f7e48417",
"display": "Low Density Lipoprotein Cholesterol"
},
{
"reference": "urn:uuid:ed567495-c2b6-45f2-a9ff-183cc642ca4e",
"display": "High Density Lipoprotein Cholesterol"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:a3c8a23f-fd20-42c2-ba18-3aacf70ea50c",
"resource": {
"resourceType": "Claim",
"id": "a3c8a23f-fd20-42c2-ba18-3aacf70ea50c",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2021-06-10T19:34:29+00:00",
"end": "2021-06-10T20:04:29+00:00"
},
"created": "2021-06-10T20:04:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:28ec8f85-d8d3-4422-82f4-94ea3542c859"
}
},
{
"sequence": 2,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:3821ba97-cd29-4d4a-990b-86b04d084e50"
}
}
],
"procedure": [
{
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:37e5857a-4622-407a-8475-f0befc132b9f"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 140.52,
"currency": "USD"
}
},
{
"sequence": 3,
"informationSequence": [
2
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "133",
"display": "Pneumococcal conjugate PCV 13"
}
],
"text": "Pneumococcal conjugate PCV 13"
},
"net": {
"value": 140.52,
"currency": "USD"
}
},
{
"sequence": 4,
"procedureSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
}
],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 562.62,
"currency": "USD"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:9992f8a7-5ff4-46e6-8f31-0f4369ffb0d6",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "9992f8a7-5ff4-46e6-8f31-0f4369ffb0d6",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicare"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Medicare"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "a3c8a23f-fd20-42c2-ba18-3aacf70ea50c"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2021-06-10T20:04:29+00:00",
"end": "2022-06-10T20:04:29+00:00"
},
"created": "2021-06-10T20:04:29+00:00",
"insurer": {
"display": "Medicare"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:a3c8a23f-fd20-42c2-ba18-3aacf70ea50c"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2021-06-10T19:34:29+00:00",
"end": "2021-06-10T20:04:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:d04faa78-626c-4b89-ab16-9c5d51713740"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2021-06-10T19:34:29+00:00",
"end": "2021-06-10T20:04:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
},
{
"sequence": 3,
"informationSequence": [
2
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "133",
"display": "Pneumococcal conjugate PCV 13"
}
],
"text": "Pneumococcal conjugate PCV 13"
},
"servicedPeriod": {
"start": "2021-06-10T19:34:29+00:00",
"end": "2021-06-10T20:04:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
},
{
"sequence": 4,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
}
],
"text": "Medication Reconciliation (procedure)"
},
"servicedPeriod": {
"start": "2021-06-10T19:34:29+00:00",
"end": "2021-06-10T20:04:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 562.62,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 112.524,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 450.096,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 562.62,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 562.62,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 674.928,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:ff892ceb-a5ba-4b35-a630-445da61242ca",
"resource": {
"resourceType": "Encounter",
"id": "ff892ceb-a5ba-4b35-a630-445da61242ca",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c",
"display": "Dr. Yael855 Hartmann983"
}
}
],
"period": {
"start": "2021-06-20T19:34:29+00:00",
"end": "2021-06-20T19:49:29+00:00"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "444814009",
"display": "Viral sinusitis (disorder)"
}
]
}
],
"serviceProvider": {
"reference": "urn:uuid:24cb4eab-6166-3530-bddc-a5a8a14a4fc1",
"display": "MILFORD REGIONAL MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:fb170fda-574a-4414-87e1-a97da559c32d",
"resource": {
"resourceType": "Condition",
"id": "fb170fda-574a-4414-87e1-a97da559c32d",
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "444814009",
"display": "Viral sinusitis (disorder)"
}
],
"text": "Viral sinusitis (disorder)"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:ff892ceb-a5ba-4b35-a630-445da61242ca"
},
"onsetDateTime": "2021-06-20T19:34:29+00:00",
"abatementDateTime": "2021-07-11T19:34:29+00:00",
"recordedDate": "2021-06-20T19:34:29+00:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "urn:uuid:22023956-26c4-42b4-8fc1-147c00988f5f",
"resource": {
"resourceType": "Claim",
"id": "22023956-26c4-42b4-8fc1-147c00988f5f",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2021-06-20T19:34:29+00:00",
"end": "2021-06-20T19:49:29+00:00"
},
"created": "2021-06-20T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:24cb4eab-6166-3530-bddc-a5a8a14a4fc1",
"display": "MILFORD REGIONAL MEDICAL CENTER"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:fb170fda-574a-4414-87e1-a97da559c32d"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
},
"encounter": [
{
"reference": "urn:uuid:ff892ceb-a5ba-4b35-a630-445da61242ca"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "444814009",
"display": "Viral sinusitis (disorder)"
}
],
"text": "Viral sinusitis (disorder)"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:60a02087-805b-4bb5-9338-84ad9a5a400a",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "60a02087-805b-4bb5-9338-84ad9a5a400a",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicare"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Medicare"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "22023956-26c4-42b4-8fc1-147c00988f5f"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2021-06-20T19:49:29+00:00",
"end": "2022-06-20T19:49:29+00:00"
},
"created": "2021-06-20T19:49:29+00:00",
"insurer": {
"display": "Medicare"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:22023956-26c4-42b4-8fc1-147c00988f5f"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:fb170fda-574a-4414-87e1-a97da559c32d"
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
}
]
}
]
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
},
"servicedPeriod": {
"start": "2021-06-20T19:34:29+00:00",
"end": "2021-06-20T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:ff892ceb-a5ba-4b35-a630-445da61242ca"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "444814009",
"display": "Viral sinusitis (disorder)"
}
],
"text": "Viral sinusitis (disorder)"
},
"servicedPeriod": {
"start": "2021-06-20T19:34:29+00:00",
"end": "2021-06-20T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
}
]
}
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b",
"resource": {
"resourceType": "Encounter",
"id": "f6c4f1d0-2360-4bbc-9698-901505bcb16b",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "2022-06-16T19:34:29+00:00",
"end": "2022-06-16T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:17c2736d-ce9b-475f-bba2-2b606ce72aea",
"resource": {
"resourceType": "Observation",
"id": "17c2736d-ce9b-475f-bba2-2b606ce72aea",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height"
}
],
"text": "Body Height"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 172.7,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:6468a021-d00a-403f-bf5b-8d86bc23aac0",
"resource": {
"resourceType": "Observation",
"id": "6468a021-d00a-403f-bf5b-8d86bc23aac0",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72514-3",
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
}
],
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:82629f96-2aa6-479c-807f-a34c05234a2e",
"resource": {
"resourceType": "Observation",
"id": "82629f96-2aa6-479c-807f-a34c05234a2e",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "29463-7",
"display": "Body Weight"
}
],
"text": "Body Weight"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 81.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:e8ddb700-d3aa-451f-be70-09d1aa9931b6",
"resource": {
"resourceType": "Observation",
"id": "e8ddb700-d3aa-451f-be70-09d1aa9931b6",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body Mass Index"
}
],
"text": "Body Mass Index"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.23,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:1fc62e69-0d6d-4f69-b5fe-972b3620e1d0",
"resource": {
"resourceType": "Observation",
"id": "1fc62e69-0d6d-4f69-b5fe-972b3620e1d0",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "85354-9",
"display": "Blood Pressure"
}
],
"text": "Blood Pressure"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 71,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 122,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:63cb8bcf-8837-4857-bcec-6444ba9f9949",
"resource": {
"resourceType": "Observation",
"id": "63cb8bcf-8837-4857-bcec-6444ba9f9949",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2339-0",
"display": "Glucose"
}
],
"text": "Glucose"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 82.76,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:4e5273f0-cf85-4ec9-be95-ff221005b5b5",
"resource": {
"resourceType": "Observation",
"id": "4e5273f0-cf85-4ec9-be95-ff221005b5b5",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6299-2",
"display": "Urea Nitrogen"
}
],
"text": "Urea Nitrogen"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 11.39,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:c8e60196-ddfe-4cad-b1e7-75e47f5f25e3",
"resource": {
"resourceType": "Observation",
"id": "c8e60196-ddfe-4cad-b1e7-75e47f5f25e3",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "38483-4",
"display": "Creatinine"
}
],
"text": "Creatinine"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 0.75,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:1e93c815-eb6e-4397-bb62-18861ed3849a",
"resource": {
"resourceType": "Observation",
"id": "1e93c815-eb6e-4397-bb62-18861ed3849a",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "49765-1",
"display": "Calcium"
}
],
"text": "Calcium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 9.03,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:5dcb152a-94aa-4375-8664-46638ac9310d",
"resource": {
"resourceType": "Observation",
"id": "5dcb152a-94aa-4375-8664-46638ac9310d",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2947-0",
"display": "Sodium"
}
],
"text": "Sodium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 136.79,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:1bdc670f-326e-4eab-a811-a00d7aca1d86",
"resource": {
"resourceType": "Observation",
"id": "1bdc670f-326e-4eab-a811-a00d7aca1d86",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6298-4",
"display": "Potassium"
}
],
"text": "Potassium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 4.33,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:ee8db11a-39ec-4282-a873-1dfe4277aa17",
"resource": {
"resourceType": "Observation",
"id": "ee8db11a-39ec-4282-a873-1dfe4277aa17",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2069-3",
"display": "Chloride"
}
],
"text": "Chloride"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 108.68,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:fa82f796-5008-4f32-8896-3501b6d9f8ae",
"resource": {
"resourceType": "Observation",
"id": "fa82f796-5008-4f32-8896-3501b6d9f8ae",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "20565-8",
"display": "Carbon Dioxide"
}
],
"text": "Carbon Dioxide"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.44,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:d7bdc1bd-d400-4246-8070-8925cdabe61c",
"resource": {
"resourceType": "Observation",
"id": "d7bdc1bd-d400-4246-8070-8925cdabe61c",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72166-2",
"display": "Tobacco smoking status NHIS"
}
],
"text": "Tobacco smoking status NHIS"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Former smoker"
}
],
"text": "Former smoker"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:73e580a4-f0da-4290-aa1f-b15454b1414b",
"resource": {
"resourceType": "Observation",
"id": "73e580a4-f0da-4290-aa1f-b15454b1414b",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
}
],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"valueQuantity": {
"value": 5.82,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:2046a312-dfde-4fae-82c4-6796fa37b22f",
"resource": {
"resourceType": "Immunization",
"id": "2046a312-dfde-4fae-82c4-6796fa37b22f",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"occurrenceDateTime": "2022-06-16T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:350e0f64-fd6e-492b-8ad3-7a6c24183103",
"resource": {
"resourceType": "Immunization",
"id": "350e0f64-fd6e-492b-8ad3-7a6c24183103",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "33",
"display": "pneumococcal polysaccharide vaccine, 23 valent"
}
],
"text": "pneumococcal polysaccharide vaccine, 23 valent"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"occurrenceDateTime": "2022-06-16T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:4dd24d4f-813b-4f5e-9b2d-fbe45d8d537d",
"resource": {
"resourceType": "DiagnosticReport",
"id": "4dd24d4f-813b-4f5e-9b2d-fbe45d8d537d",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic Metabolic Panel"
}
],
"text": "Basic Metabolic Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
},
"effectiveDateTime": "2022-06-16T19:34:29+00:00",
"issued": "2022-06-16T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:63cb8bcf-8837-4857-bcec-6444ba9f9949",
"display": "Glucose"
},
{
"reference": "urn:uuid:4e5273f0-cf85-4ec9-be95-ff221005b5b5",
"display": "Urea Nitrogen"
},
{
"reference": "urn:uuid:c8e60196-ddfe-4cad-b1e7-75e47f5f25e3",
"display": "Creatinine"
},
{
"reference": "urn:uuid:1e93c815-eb6e-4397-bb62-18861ed3849a",
"display": "Calcium"
},
{
"reference": "urn:uuid:5dcb152a-94aa-4375-8664-46638ac9310d",
"display": "Sodium"
},
{
"reference": "urn:uuid:1bdc670f-326e-4eab-a811-a00d7aca1d86",
"display": "Potassium"
},
{
"reference": "urn:uuid:ee8db11a-39ec-4282-a873-1dfe4277aa17",
"display": "Chloride"
},
{
"reference": "urn:uuid:fa82f796-5008-4f32-8896-3501b6d9f8ae",
"display": "Carbon Dioxide"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:c1f052fa-84c4-4da1-a4cf-761b0891afa5",
"resource": {
"resourceType": "Claim",
"id": "c1f052fa-84c4-4da1-a4cf-761b0891afa5",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2022-06-16T19:34:29+00:00",
"end": "2022-06-16T19:49:29+00:00"
},
"created": "2022-06-16T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:2046a312-dfde-4fae-82c4-6796fa37b22f"
}
},
{
"sequence": 2,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:350e0f64-fd6e-492b-8ad3-7a6c24183103"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 140.52,
"currency": "USD"
}
},
{
"sequence": 3,
"informationSequence": [
2
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "33",
"display": "pneumococcal polysaccharide vaccine, 23 valent"
}
],
"text": "pneumococcal polysaccharide vaccine, 23 valent"
},
"net": {
"value": 140.52,
"currency": "USD"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:54c0308a-70c2-4b41-98b6-5a1842c244c0",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "54c0308a-70c2-4b41-98b6-5a1842c244c0",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicare"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Medicare"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "c1f052fa-84c4-4da1-a4cf-761b0891afa5"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2022-06-16T19:49:29+00:00",
"end": "2023-06-16T19:49:29+00:00"
},
"created": "2022-06-16T19:49:29+00:00",
"insurer": {
"display": "Medicare"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:c1f052fa-84c4-4da1-a4cf-761b0891afa5"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2022-06-16T19:34:29+00:00",
"end": "2022-06-16T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:f6c4f1d0-2360-4bbc-9698-901505bcb16b"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2022-06-16T19:34:29+00:00",
"end": "2022-06-16T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
},
{
"sequence": 3,
"informationSequence": [
2
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "33",
"display": "pneumococcal polysaccharide vaccine, 23 valent"
}
],
"text": "pneumococcal polysaccharide vaccine, 23 valent"
},
"servicedPeriod": {
"start": "2022-06-16T19:34:29+00:00",
"end": "2022-06-16T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 224.83200000000002,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:fd800460-8a7e-4c3a-bb72-cecd610ba12b",
"resource": {
"resourceType": "Encounter",
"id": "fd800460-8a7e-4c3a-bb72-cecd610ba12b",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c",
"display": "Dr. Yael855 Hartmann983"
}
}
],
"period": {
"start": "2022-07-02T19:34:29+00:00",
"end": "2022-07-02T19:49:29+00:00"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
}
]
}
],
"serviceProvider": {
"reference": "urn:uuid:24cb4eab-6166-3530-bddc-a5a8a14a4fc1",
"display": "MILFORD REGIONAL MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:fe6b558d-6162-4f19-9ea4-0346f24c8d57",
"resource": {
"resourceType": "Condition",
"id": "fe6b558d-6162-4f19-9ea4-0346f24c8d57",
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
}
],
"text": "Acute viral pharyngitis (disorder)"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fd800460-8a7e-4c3a-bb72-cecd610ba12b"
},
"onsetDateTime": "2022-07-02T19:34:29+00:00",
"abatementDateTime": "2022-07-09T19:34:29+00:00",
"recordedDate": "2022-07-02T19:34:29+00:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "urn:uuid:1b602220-1630-4de7-844a-2d8cbbe8ad7b",
"resource": {
"resourceType": "Observation",
"id": "1b602220-1630-4de7-844a-2d8cbbe8ad7b",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8331-1",
"display": "Oral temperature"
}
],
"text": "Oral temperature"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:fd800460-8a7e-4c3a-bb72-cecd610ba12b"
},
"effectiveDateTime": "2022-07-02T19:34:29+00:00",
"issued": "2022-07-02T19:34:29.095+00:00",
"valueQuantity": {
"value": 37.369,
"unit": "Cel",
"system": "http://unitsofmeasure.org",
"code": "Cel"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:fa7c3954-c9ab-433e-8196-525e1228208e",
"resource": {
"resourceType": "Claim",
"id": "fa7c3954-c9ab-433e-8196-525e1228208e",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2022-07-02T19:34:29+00:00",
"end": "2022-07-02T19:49:29+00:00"
},
"created": "2022-07-02T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:24cb4eab-6166-3530-bddc-a5a8a14a4fc1",
"display": "MILFORD REGIONAL MEDICAL CENTER"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:fe6b558d-6162-4f19-9ea4-0346f24c8d57"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
},
"encounter": [
{
"reference": "urn:uuid:fd800460-8a7e-4c3a-bb72-cecd610ba12b"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
}
],
"text": "Acute viral pharyngitis (disorder)"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:12890e67-81e1-47bb-bc5c-de2bbbc191c2",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "12890e67-81e1-47bb-bc5c-de2bbbc191c2",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicare"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Medicare"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "fa7c3954-c9ab-433e-8196-525e1228208e"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2022-07-02T19:49:29+00:00",
"end": "2023-07-02T19:49:29+00:00"
},
"created": "2022-07-02T19:49:29+00:00",
"insurer": {
"display": "Medicare"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:fa7c3954-c9ab-433e-8196-525e1228208e"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000017c"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:fe6b558d-6162-4f19-9ea4-0346f24c8d57"
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
}
]
}
]
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
}
],
"text": "Encounter for symptom"
},
"servicedPeriod": {
"start": "2022-07-02T19:34:29+00:00",
"end": "2022-07-02T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:fd800460-8a7e-4c3a-bb72-cecd610ba12b"
}
]
},
{
"sequence": 2,
"diagnosisSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
}
],
"text": "Acute viral pharyngitis (disorder)"
},
"servicedPeriod": {
"start": "2022-07-02T19:34:29+00:00",
"end": "2022-07-02T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
}
]
}
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f",
"resource": {
"resourceType": "Encounter",
"id": "5cca10ed-10d2-45f9-afbf-bdcf11a3142f",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "2023-06-22T19:34:29+00:00",
"end": "2023-06-22T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:85e08178-df03-4072-962b-104ad55635d0",
"resource": {
"resourceType": "Observation",
"id": "85e08178-df03-4072-962b-104ad55635d0",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height"
}
],
"text": "Body Height"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 172.7,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:9ed5ed29-ce07-47a4-a58e-30c2a86e6bb0",
"resource": {
"resourceType": "Observation",
"id": "9ed5ed29-ce07-47a4-a58e-30c2a86e6bb0",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72514-3",
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
}
],
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:9eff0f15-d69d-4fe9-8c8e-48fb2bc055d2",
"resource": {
"resourceType": "Observation",
"id": "9eff0f15-d69d-4fe9-8c8e-48fb2bc055d2",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "29463-7",
"display": "Body Weight"
}
],
"text": "Body Weight"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 81.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:537bb268-b708-43af-b06a-f53cf10c1218",
"resource": {
"resourceType": "Observation",
"id": "537bb268-b708-43af-b06a-f53cf10c1218",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body Mass Index"
}
],
"text": "Body Mass Index"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.23,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:b2cab7d5-05c0-44f3-9ad3-059cf5a5cc4c",
"resource": {
"resourceType": "Observation",
"id": "b2cab7d5-05c0-44f3-9ad3-059cf5a5cc4c",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "85354-9",
"display": "Blood Pressure"
}
],
"text": "Blood Pressure"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 72,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 133,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:5c31d37a-4584-4c81-969a-781289d5ea42",
"resource": {
"resourceType": "Observation",
"id": "5c31d37a-4584-4c81-969a-781289d5ea42",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2339-0",
"display": "Glucose"
}
],
"text": "Glucose"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 75.59,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:29193fa6-0188-47a2-9e53-d65ef81d4d66",
"resource": {
"resourceType": "Observation",
"id": "29193fa6-0188-47a2-9e53-d65ef81d4d66",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6299-2",
"display": "Urea Nitrogen"
}
],
"text": "Urea Nitrogen"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 13.1,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:6137c4fa-f860-4cb6-9dc4-f38c218b7b6d",
"resource": {
"resourceType": "Observation",
"id": "6137c4fa-f860-4cb6-9dc4-f38c218b7b6d",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "38483-4",
"display": "Creatinine"
}
],
"text": "Creatinine"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 1.03,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:c6ef94e2-27de-481a-b6de-bf070a342d1f",
"resource": {
"resourceType": "Observation",
"id": "c6ef94e2-27de-481a-b6de-bf070a342d1f",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "49765-1",
"display": "Calcium"
}
],
"text": "Calcium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 9.68,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:38973399-3fdd-460d-943d-9cb9c5dd84e5",
"resource": {
"resourceType": "Observation",
"id": "38973399-3fdd-460d-943d-9cb9c5dd84e5",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2947-0",
"display": "Sodium"
}
],
"text": "Sodium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 139.48,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:869763f4-13b3-4c7a-82e2-b2ac5a1585af",
"resource": {
"resourceType": "Observation",
"id": "869763f4-13b3-4c7a-82e2-b2ac5a1585af",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6298-4",
"display": "Potassium"
}
],
"text": "Potassium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 4.39,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:52b353e0-af49-4a5f-bb02-d42fa061c699",
"resource": {
"resourceType": "Observation",
"id": "52b353e0-af49-4a5f-bb02-d42fa061c699",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2069-3",
"display": "Chloride"
}
],
"text": "Chloride"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 104.99,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:1fab7918-0ef4-4ade-89ec-d7c082a3d5d8",
"resource": {
"resourceType": "Observation",
"id": "1fab7918-0ef4-4ade-89ec-d7c082a3d5d8",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "20565-8",
"display": "Carbon Dioxide"
}
],
"text": "Carbon Dioxide"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 22.25,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:3d27cf33-cb1f-4f23-94a0-ddf0135ba4c0",
"resource": {
"resourceType": "Observation",
"id": "3d27cf33-cb1f-4f23-94a0-ddf0135ba4c0",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6690-2",
"display": "Leukocytes [#/volume] in Blood by Automated count"
}
],
"text": "Leukocytes [#/volume] in Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 8.5378,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:ccb28fc2-e56a-4d1c-a45e-b8418be417d4",
"resource": {
"resourceType": "Observation",
"id": "ccb28fc2-e56a-4d1c-a45e-b8418be417d4",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "789-8",
"display": "Erythrocytes [#/volume] in Blood by Automated count"
}
],
"text": "Erythrocytes [#/volume] in Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 4.3068,
"unit": "10*6/uL",
"system": "http://unitsofmeasure.org",
"code": "10*6/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:73a455c5-7a6c-40ed-962e-2e20b1a98f83",
"resource": {
"resourceType": "Observation",
"id": "73a455c5-7a6c-40ed-962e-2e20b1a98f83",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "718-7",
"display": "Hemoglobin [Mass/volume] in Blood"
}
],
"text": "Hemoglobin [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 17.313,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:8eade714-e8a7-46aa-849d-b6247be6d93d",
"resource": {
"resourceType": "Observation",
"id": "8eade714-e8a7-46aa-849d-b6247be6d93d",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4544-3",
"display": "Hematocrit [Volume Fraction] of Blood by Automated count"
}
],
"text": "Hematocrit [Volume Fraction] of Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 36.389,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:310877c6-c891-4813-8ab1-dcc410fab812",
"resource": {
"resourceType": "Observation",
"id": "310877c6-c891-4813-8ab1-dcc410fab812",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "787-2",
"display": "MCV [Entitic volume] by Automated count"
}
],
"text": "MCV [Entitic volume] by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 88.221,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:0d48e0fc-3b29-41a0-b405-7b867ccf13b5",
"resource": {
"resourceType": "Observation",
"id": "0d48e0fc-3b29-41a0-b405-7b867ccf13b5",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "785-6",
"display": "MCH [Entitic mass] by Automated count"
}
],
"text": "MCH [Entitic mass] by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 32.586,
"unit": "pg",
"system": "http://unitsofmeasure.org",
"code": "pg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:84aa3ad9-9b44-4243-b38d-f818b1cfe9e3",
"resource": {
"resourceType": "Observation",
"id": "84aa3ad9-9b44-4243-b38d-f818b1cfe9e3",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "786-4",
"display": "MCHC [Mass/volume] by Automated count"
}
],
"text": "MCHC [Mass/volume] by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 35.034,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:34d4d7b8-bab3-440b-a595-73ae80f71b1d",
"resource": {
"resourceType": "Observation",
"id": "34d4d7b8-bab3-440b-a595-73ae80f71b1d",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "21000-5",
"display": "Erythrocyte distribution width [Entitic volume] by Automated count"
}
],
"text": "Erythrocyte distribution width [Entitic volume] by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 42.895,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:98b3ef1d-f73d-4b3f-a0ec-f1140ad496ac",
"resource": {
"resourceType": "Observation",
"id": "98b3ef1d-f73d-4b3f-a0ec-f1140ad496ac",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "777-3",
"display": "Platelets [#/volume] in Blood by Automated count"
}
],
"text": "Platelets [#/volume] in Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 426.15,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:2d63c1f3-fa94-4efb-9061-86cfc7741c3a",
"resource": {
"resourceType": "Observation",
"id": "2d63c1f3-fa94-4efb-9061-86cfc7741c3a",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "32207-3",
"display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
}
],
"text": "Platelet distribution width [Entitic volume] in Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 380.95,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:b0c29ead-2525-4da6-9529-00d2f2f919fe",
"resource": {
"resourceType": "Observation",
"id": "b0c29ead-2525-4da6-9529-00d2f2f919fe",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "32623-1",
"display": "Platelet mean volume [Entitic volume] in Blood by Automated count"
}
],
"text": "Platelet mean volume [Entitic volume] in Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 11.74,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:dcd6f238-8904-43cb-a487-efa31a5f8ef6",
"resource": {
"resourceType": "Observation",
"id": "dcd6f238-8904-43cb-a487-efa31a5f8ef6",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72166-2",
"display": "Tobacco smoking status NHIS"
}
],
"text": "Tobacco smoking status NHIS"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Former smoker"
}
],
"text": "Former smoker"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:860b58f4-ecda-42c1-aec9-6f681ce99e70",
"resource": {
"resourceType": "Observation",
"id": "860b58f4-ecda-42c1-aec9-6f681ce99e70",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
}
],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"valueQuantity": {
"value": 6.26,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:89af7cf8-4a8d-4f31-9b94-025d215fd975",
"resource": {
"resourceType": "Immunization",
"id": "89af7cf8-4a8d-4f31-9b94-025d215fd975",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"occurrenceDateTime": "2023-06-22T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:09ddb8df-b91c-4f6a-ba8f-9c5544670b6d",
"resource": {
"resourceType": "DiagnosticReport",
"id": "09ddb8df-b91c-4f6a-ba8f-9c5544670b6d",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic Metabolic Panel"
}
],
"text": "Basic Metabolic Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:5c31d37a-4584-4c81-969a-781289d5ea42",
"display": "Glucose"
},
{
"reference": "urn:uuid:29193fa6-0188-47a2-9e53-d65ef81d4d66",
"display": "Urea Nitrogen"
},
{
"reference": "urn:uuid:6137c4fa-f860-4cb6-9dc4-f38c218b7b6d",
"display": "Creatinine"
},
{
"reference": "urn:uuid:c6ef94e2-27de-481a-b6de-bf070a342d1f",
"display": "Calcium"
},
{
"reference": "urn:uuid:38973399-3fdd-460d-943d-9cb9c5dd84e5",
"display": "Sodium"
},
{
"reference": "urn:uuid:869763f4-13b3-4c7a-82e2-b2ac5a1585af",
"display": "Potassium"
},
{
"reference": "urn:uuid:52b353e0-af49-4a5f-bb02-d42fa061c699",
"display": "Chloride"
},
{
"reference": "urn:uuid:1fab7918-0ef4-4ade-89ec-d7c082a3d5d8",
"display": "Carbon Dioxide"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:b03032a0-413a-4d30-995a-b3c21f8175c1",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b03032a0-413a-4d30-995a-b3c21f8175c1",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "58410-2",
"display": "Complete blood count (hemogram) panel - Blood by Automated count"
}
],
"text": "Complete blood count (hemogram) panel - Blood by Automated count"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
},
"effectiveDateTime": "2023-06-22T19:34:29+00:00",
"issued": "2023-06-22T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:3d27cf33-cb1f-4f23-94a0-ddf0135ba4c0",
"display": "Leukocytes [#/volume] in Blood by Automated count"
},
{
"reference": "urn:uuid:ccb28fc2-e56a-4d1c-a45e-b8418be417d4",
"display": "Erythrocytes [#/volume] in Blood by Automated count"
},
{
"reference": "urn:uuid:73a455c5-7a6c-40ed-962e-2e20b1a98f83",
"display": "Hemoglobin [Mass/volume] in Blood"
},
{
"reference": "urn:uuid:8eade714-e8a7-46aa-849d-b6247be6d93d",
"display": "Hematocrit [Volume Fraction] of Blood by Automated count"
},
{
"reference": "urn:uuid:310877c6-c891-4813-8ab1-dcc410fab812",
"display": "MCV [Entitic volume] by Automated count"
},
{
"reference": "urn:uuid:0d48e0fc-3b29-41a0-b405-7b867ccf13b5",
"display": "MCH [Entitic mass] by Automated count"
},
{
"reference": "urn:uuid:84aa3ad9-9b44-4243-b38d-f818b1cfe9e3",
"display": "MCHC [Mass/volume] by Automated count"
},
{
"reference": "urn:uuid:34d4d7b8-bab3-440b-a595-73ae80f71b1d",
"display": "Erythrocyte distribution width [Entitic volume] by Automated count"
},
{
"reference": "urn:uuid:98b3ef1d-f73d-4b3f-a0ec-f1140ad496ac",
"display": "Platelets [#/volume] in Blood by Automated count"
},
{
"reference": "urn:uuid:2d63c1f3-fa94-4efb-9061-86cfc7741c3a",
"display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
},
{
"reference": "urn:uuid:b0c29ead-2525-4da6-9529-00d2f2f919fe",
"display": "Platelet mean volume [Entitic volume] in Blood by Automated count"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:4ea3942f-de75-4daa-ae02-8b80315a10e7",
"resource": {
"resourceType": "Claim",
"id": "4ea3942f-de75-4daa-ae02-8b80315a10e7",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2023-06-22T19:34:29+00:00",
"end": "2023-06-22T19:49:29+00:00"
},
"created": "2023-06-22T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:89af7cf8-4a8d-4f31-9b94-025d215fd975"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 140.52,
"currency": "USD"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:249e7a40-d1a6-4afb-ab2d-8ef9046c415c",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "249e7a40-d1a6-4afb-ab2d-8ef9046c415c",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicare"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Medicare"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "4ea3942f-de75-4daa-ae02-8b80315a10e7"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2023-06-22T19:49:29+00:00",
"end": "2024-06-22T19:49:29+00:00"
},
"created": "2023-06-22T19:49:29+00:00",
"insurer": {
"display": "Medicare"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:4ea3942f-de75-4daa-ae02-8b80315a10e7"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2023-06-22T19:34:29+00:00",
"end": "2023-06-22T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:5cca10ed-10d2-45f9-afbf-bdcf11a3142f"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2023-06-22T19:34:29+00:00",
"end": "2023-06-22T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5",
"resource": {
"resourceType": "Encounter",
"id": "d5adf4d4-433a-4d55-a1ff-b354037853e5",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "2024-06-27T19:34:29+00:00",
"end": "2024-06-27T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:69ed095d-b7a3-4cc0-8a43-494bb3a2a7d5",
"resource": {
"resourceType": "Observation",
"id": "69ed095d-b7a3-4cc0-8a43-494bb3a2a7d5",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height"
}
],
"text": "Body Height"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 172.7,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:a91301d9-8da2-484b-8106-ac9a07c06a79",
"resource": {
"resourceType": "Observation",
"id": "a91301d9-8da2-484b-8106-ac9a07c06a79",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72514-3",
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
}
],
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 4,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:2d9c34d5-f8f4-4c54-b984-8dd2338000f2",
"resource": {
"resourceType": "Observation",
"id": "2d9c34d5-f8f4-4c54-b984-8dd2338000f2",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "29463-7",
"display": "Body Weight"
}
],
"text": "Body Weight"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 81.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:13a2b51f-bba9-4bd8-8239-717be4d1b1c7",
"resource": {
"resourceType": "Observation",
"id": "13a2b51f-bba9-4bd8-8239-717be4d1b1c7",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body Mass Index"
}
],
"text": "Body Mass Index"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.23,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:56620a75-935e-4ee8-9d4a-0ddd0d2e4db1",
"resource": {
"resourceType": "Observation",
"id": "56620a75-935e-4ee8-9d4a-0ddd0d2e4db1",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "85354-9",
"display": "Blood Pressure"
}
],
"text": "Blood Pressure"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 81,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 126,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:10fa9347-6358-4447-b006-b0b9693a3a3d",
"resource": {
"resourceType": "Observation",
"id": "10fa9347-6358-4447-b006-b0b9693a3a3d",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2339-0",
"display": "Glucose"
}
],
"text": "Glucose"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 68.93,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:4186b7f5-e3be-4dc5-8ddf-1184883b95f2",
"resource": {
"resourceType": "Observation",
"id": "4186b7f5-e3be-4dc5-8ddf-1184883b95f2",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6299-2",
"display": "Urea Nitrogen"
}
],
"text": "Urea Nitrogen"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 19.79,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:59ab08b3-ea54-4824-a528-e4f7bf184f32",
"resource": {
"resourceType": "Observation",
"id": "59ab08b3-ea54-4824-a528-e4f7bf184f32",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "38483-4",
"display": "Creatinine"
}
],
"text": "Creatinine"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 0.69,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:167dab53-c5d7-448b-bb44-7c66567f8820",
"resource": {
"resourceType": "Observation",
"id": "167dab53-c5d7-448b-bb44-7c66567f8820",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "49765-1",
"display": "Calcium"
}
],
"text": "Calcium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 9.14,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:798fef08-cfa4-4815-b525-6c61e555b75c",
"resource": {
"resourceType": "Observation",
"id": "798fef08-cfa4-4815-b525-6c61e555b75c",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2947-0",
"display": "Sodium"
}
],
"text": "Sodium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 142.48,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:e9b1d9cb-5a84-422c-8e78-54bb328ef853",
"resource": {
"resourceType": "Observation",
"id": "e9b1d9cb-5a84-422c-8e78-54bb328ef853",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6298-4",
"display": "Potassium"
}
],
"text": "Potassium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 4.84,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:f615f5e6-b735-4c8e-a41e-bbe6ab8a7fd8",
"resource": {
"resourceType": "Observation",
"id": "f615f5e6-b735-4c8e-a41e-bbe6ab8a7fd8",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2069-3",
"display": "Chloride"
}
],
"text": "Chloride"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 109.55,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:d533c8d4-8790-4580-8321-2deedfda61df",
"resource": {
"resourceType": "Observation",
"id": "d533c8d4-8790-4580-8321-2deedfda61df",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "20565-8",
"display": "Carbon Dioxide"
}
],
"text": "Carbon Dioxide"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 20.7,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:0c64c7ca-5cf1-4516-948c-83abcb72790f",
"resource": {
"resourceType": "Observation",
"id": "0c64c7ca-5cf1-4516-948c-83abcb72790f",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2093-3",
"display": "Total Cholesterol"
}
],
"text": "Total Cholesterol"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 182.32,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:cbf0d804-012e-453c-a19d-7853423ba5b2",
"resource": {
"resourceType": "Observation",
"id": "cbf0d804-012e-453c-a19d-7853423ba5b2",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2571-8",
"display": "Triglycerides"
}
],
"text": "Triglycerides"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 146.95,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:21765bed-6c04-496d-8b28-26f8d431f104",
"resource": {
"resourceType": "Observation",
"id": "21765bed-6c04-496d-8b28-26f8d431f104",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "18262-6",
"display": "Low Density Lipoprotein Cholesterol"
}
],
"text": "Low Density Lipoprotein Cholesterol"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 88.24,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:b178d33b-511c-4ba2-bb25-3fb2221714bc",
"resource": {
"resourceType": "Observation",
"id": "b178d33b-511c-4ba2-bb25-3fb2221714bc",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2085-9",
"display": "High Density Lipoprotein Cholesterol"
}
],
"text": "High Density Lipoprotein Cholesterol"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 64.69,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:f0b90385-e675-4fbe-b97f-427e6bf1e308",
"resource": {
"resourceType": "Observation",
"id": "f0b90385-e675-4fbe-b97f-427e6bf1e308",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72166-2",
"display": "Tobacco smoking status NHIS"
}
],
"text": "Tobacco smoking status NHIS"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Former smoker"
}
],
"text": "Former smoker"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:9df2221e-046a-4794-9d50-0ba7e7188b19",
"resource": {
"resourceType": "Observation",
"id": "9df2221e-046a-4794-9d50-0ba7e7188b19",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
}
],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"valueQuantity": {
"value": 6.15,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:4801e30e-ec69-4244-b034-f21c1a0042b1",
"resource": {
"resourceType": "Immunization",
"id": "4801e30e-ec69-4244-b034-f21c1a0042b1",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"occurrenceDateTime": "2024-06-27T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:ba3402f0-fe90-4028-9641-525446f34793",
"resource": {
"resourceType": "DiagnosticReport",
"id": "ba3402f0-fe90-4028-9641-525446f34793",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic Metabolic Panel"
}
],
"text": "Basic Metabolic Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:10fa9347-6358-4447-b006-b0b9693a3a3d",
"display": "Glucose"
},
{
"reference": "urn:uuid:4186b7f5-e3be-4dc5-8ddf-1184883b95f2",
"display": "Urea Nitrogen"
},
{
"reference": "urn:uuid:59ab08b3-ea54-4824-a528-e4f7bf184f32",
"display": "Creatinine"
},
{
"reference": "urn:uuid:167dab53-c5d7-448b-bb44-7c66567f8820",
"display": "Calcium"
},
{
"reference": "urn:uuid:798fef08-cfa4-4815-b525-6c61e555b75c",
"display": "Sodium"
},
{
"reference": "urn:uuid:e9b1d9cb-5a84-422c-8e78-54bb328ef853",
"display": "Potassium"
},
{
"reference": "urn:uuid:f615f5e6-b735-4c8e-a41e-bbe6ab8a7fd8",
"display": "Chloride"
},
{
"reference": "urn:uuid:d533c8d4-8790-4580-8321-2deedfda61df",
"display": "Carbon Dioxide"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:b9f6335b-91cb-4270-a6f2-ca8cc78fb028",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b9f6335b-91cb-4270-a6f2-ca8cc78fb028",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "57698-3",
"display": "Lipid Panel"
}
],
"text": "Lipid Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
},
"effectiveDateTime": "2024-06-27T19:34:29+00:00",
"issued": "2024-06-27T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:0c64c7ca-5cf1-4516-948c-83abcb72790f",
"display": "Total Cholesterol"
},
{
"reference": "urn:uuid:cbf0d804-012e-453c-a19d-7853423ba5b2",
"display": "Triglycerides"
},
{
"reference": "urn:uuid:21765bed-6c04-496d-8b28-26f8d431f104",
"display": "Low Density Lipoprotein Cholesterol"
},
{
"reference": "urn:uuid:b178d33b-511c-4ba2-bb25-3fb2221714bc",
"display": "High Density Lipoprotein Cholesterol"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:3995d67f-5502-4cd8-b11e-aa3583e2123d",
"resource": {
"resourceType": "Claim",
"id": "3995d67f-5502-4cd8-b11e-aa3583e2123d",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2024-06-27T19:34:29+00:00",
"end": "2024-06-27T19:49:29+00:00"
},
"created": "2024-06-27T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:4801e30e-ec69-4244-b034-f21c1a0042b1"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 140.52,
"currency": "USD"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:b0823782-87db-487d-8678-200be37dd876",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "b0823782-87db-487d-8678-200be37dd876",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicare"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Medicare"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "3995d67f-5502-4cd8-b11e-aa3583e2123d"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2024-06-27T19:49:29+00:00",
"end": "2025-06-27T19:49:29+00:00"
},
"created": "2024-06-27T19:49:29+00:00",
"insurer": {
"display": "Medicare"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:3995d67f-5502-4cd8-b11e-aa3583e2123d"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2024-06-27T19:34:29+00:00",
"end": "2024-06-27T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:d5adf4d4-433a-4d55-a1ff-b354037853e5"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2024-06-27T19:34:29+00:00",
"end": "2024-06-27T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc",
"resource": {
"resourceType": "Encounter",
"id": "6926858e-f9f1-4c3d-b3af-d1eaccccfadc",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Mrs. Alisia5 Ziemann98"
},
"participant": [
{
"individual": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8",
"display": "Dr. Fritz267 Lebsack687"
}
}
],
"period": {
"start": "2025-07-03T19:34:29+00:00",
"end": "2025-07-03T19:49:29+00:00"
},
"serviceProvider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "urn:uuid:24de340a-ae7a-42f6-bf22-8cd7fb623a49",
"resource": {
"resourceType": "Observation",
"id": "24de340a-ae7a-42f6-bf22-8cd7fb623a49",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height"
}
],
"text": "Body Height"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 172.7,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:801bb9b7-3362-4cdc-9085-cce9065eaae8",
"resource": {
"resourceType": "Observation",
"id": "801bb9b7-3362-4cdc-9085-cce9065eaae8",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72514-3",
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
}
],
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 3,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:bd6a1bf3-e2c6-48bc-ae44-2393a3b48885",
"resource": {
"resourceType": "Observation",
"id": "bd6a1bf3-e2c6-48bc-ae44-2393a3b48885",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "29463-7",
"display": "Body Weight"
}
],
"text": "Body Weight"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 81.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:9d839f50-ccb0-4852-9363-7c96b800b2b7",
"resource": {
"resourceType": "Observation",
"id": "9d839f50-ccb0-4852-9363-7c96b800b2b7",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body Mass Index"
}
],
"text": "Body Mass Index"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.23,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:7d00cbaf-56d5-49f5-8986-9bfdb4967f79",
"resource": {
"resourceType": "Observation",
"id": "7d00cbaf-56d5-49f5-8986-9bfdb4967f79",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "vital-signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "85354-9",
"display": "Blood Pressure"
}
],
"text": "Blood Pressure"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"component": [
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 72,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
},
{
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 102,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:21f0552d-933f-437c-a54f-2628d0f28349",
"resource": {
"resourceType": "Observation",
"id": "21f0552d-933f-437c-a54f-2628d0f28349",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2339-0",
"display": "Glucose"
}
],
"text": "Glucose"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 78.8,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:a836c879-1018-40af-9c85-1584a26d50d7",
"resource": {
"resourceType": "Observation",
"id": "a836c879-1018-40af-9c85-1584a26d50d7",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6299-2",
"display": "Urea Nitrogen"
}
],
"text": "Urea Nitrogen"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 12.52,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:68031297-6ec0-45e5-99bc-d444a6615828",
"resource": {
"resourceType": "Observation",
"id": "68031297-6ec0-45e5-99bc-d444a6615828",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "38483-4",
"display": "Creatinine"
}
],
"text": "Creatinine"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 0.68,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:722d8e2b-e35c-4724-aac3-2a9a9ac23599",
"resource": {
"resourceType": "Observation",
"id": "722d8e2b-e35c-4724-aac3-2a9a9ac23599",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "49765-1",
"display": "Calcium"
}
],
"text": "Calcium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 9.51,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:8096456f-0104-4845-92fa-1da929f65154",
"resource": {
"resourceType": "Observation",
"id": "8096456f-0104-4845-92fa-1da929f65154",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2947-0",
"display": "Sodium"
}
],
"text": "Sodium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 143.23,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:de06ec0a-b067-47d7-97b1-3baa235af47d",
"resource": {
"resourceType": "Observation",
"id": "de06ec0a-b067-47d7-97b1-3baa235af47d",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6298-4",
"display": "Potassium"
}
],
"text": "Potassium"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 4.56,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:e946e3fd-b4ca-408b-bbac-565146737b6b",
"resource": {
"resourceType": "Observation",
"id": "e946e3fd-b4ca-408b-bbac-565146737b6b",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "2069-3",
"display": "Chloride"
}
],
"text": "Chloride"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 103.01,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:953c227c-b77d-49a5-bff7-e44e71f80770",
"resource": {
"resourceType": "Observation",
"id": "953c227c-b77d-49a5-bff7-e44e71f80770",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "20565-8",
"display": "Carbon Dioxide"
}
],
"text": "Carbon Dioxide"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 27.44,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:6d1a8a08-fb1d-4649-87b7-42371d7868c4",
"resource": {
"resourceType": "Observation",
"id": "6d1a8a08-fb1d-4649-87b7-42371d7868c4",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "72166-2",
"display": "Tobacco smoking status NHIS"
}
],
"text": "Tobacco smoking status NHIS"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Former smoker"
}
],
"text": "Former smoker"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:0ebd5f2a-17e5-4f9c-92a8-f9019fe86a3b",
"resource": {
"resourceType": "Observation",
"id": "0ebd5f2a-17e5-4f9c-92a8-f9019fe86a3b",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
}
],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"valueQuantity": {
"value": 6.37,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "urn:uuid:c70487a1-c016-40ae-9313-f63207394dca",
"resource": {
"resourceType": "Immunization",
"id": "c70487a1-c016-40ae-9313-f63207394dca",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"occurrenceDateTime": "2025-07-03T19:34:29+00:00",
"primarySource": true
},
"request": {
"method": "POST",
"url": "Immunization"
}
},
{
"fullUrl": "urn:uuid:77636948-95a9-4be0-ad8d-3b5581e59dca",
"resource": {
"resourceType": "DiagnosticReport",
"id": "77636948-95a9-4be0-ad8d-3b5581e59dca",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic Metabolic Panel"
}
],
"text": "Basic Metabolic Panel"
},
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"encounter": {
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
},
"effectiveDateTime": "2025-07-03T19:34:29+00:00",
"issued": "2025-07-03T19:34:29.095+00:00",
"result": [
{
"reference": "urn:uuid:21f0552d-933f-437c-a54f-2628d0f28349",
"display": "Glucose"
},
{
"reference": "urn:uuid:a836c879-1018-40af-9c85-1584a26d50d7",
"display": "Urea Nitrogen"
},
{
"reference": "urn:uuid:68031297-6ec0-45e5-99bc-d444a6615828",
"display": "Creatinine"
},
{
"reference": "urn:uuid:722d8e2b-e35c-4724-aac3-2a9a9ac23599",
"display": "Calcium"
},
{
"reference": "urn:uuid:8096456f-0104-4845-92fa-1da929f65154",
"display": "Sodium"
},
{
"reference": "urn:uuid:de06ec0a-b067-47d7-97b1-3baa235af47d",
"display": "Potassium"
},
{
"reference": "urn:uuid:e946e3fd-b4ca-408b-bbac-565146737b6b",
"display": "Chloride"
},
{
"reference": "urn:uuid:953c227c-b77d-49a5-bff7-e44e71f80770",
"display": "Carbon Dioxide"
}
]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
},
{
"fullUrl": "urn:uuid:3bc255df-ca20-4d59-a354-eafacdec69e8",
"resource": {
"resourceType": "Claim",
"id": "3bc255df-ca20-4d59-a354-eafacdec69e8",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a",
"display": "Alisia5 Ziemann98"
},
"billablePeriod": {
"start": "2025-07-03T19:34:29+00:00",
"end": "2025-07-03T19:49:29+00:00"
},
"created": "2025-07-03T19:49:29+00:00",
"provider": {
"reference": "urn:uuid:b0d46e53-6b47-354a-9ddb-9ed9302ae9f5",
"display": "PCP114062"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
}
]
},
"valueReference": {
"reference": "urn:uuid:c70487a1-c016-40ae-9313-f63207394dca"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"encounter": [
{
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 140.52,
"currency": "USD"
}
}
],
"total": {
"value": 129.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
},
{
"fullUrl": "urn:uuid:3de35789-04c8-4ca0-baa6-c17d7bcc5c17",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "3de35789-04c8-4ca0-baa6-c17d7bcc5c17",
"contained": [
{
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"requester": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"performer": [
{
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicare"
},
"beneficiary": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"payor": [
{
"display": "Medicare"
}
]
}
],
"identifier": [
{
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "3bc255df-ca20-4d59-a354-eafacdec69e8"
},
{
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"billablePeriod": {
"start": "2025-07-03T19:49:29+00:00",
"end": "2026-07-03T19:49:29+00:00"
},
"created": "2025-07-03T19:49:29+00:00",
"insurer": {
"display": "Medicare"
},
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"referral": {
"reference": "#referral"
},
"claim": {
"reference": "urn:uuid:3bc255df-ca20-4d59-a354-eafacdec69e8"
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:00000199-be0b-2ec3-0000-00000000b2e8"
},
"role": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary Care Practitioner"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicare"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
}
],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2025-07-03T19:34:29+00:00",
"end": "2025-07-03T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"encounter": [
{
"reference": "urn:uuid:6926858e-f9f1-4c3d-b3af-d1eaccccfadc"
}
]
},
{
"sequence": 2,
"informationSequence": [
1
],
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
}
],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2025-07-03T19:34:29+00:00",
"end": "2025-07-03T19:49:29+00:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
}
]
},
"net": {
"value": 140.52,
"currency": "USD"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
}
]
},
"amount": {
"value": 28.104000000000003,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
}
]
},
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 140.52,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 129.16,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 112.41600000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
},
{
"fullUrl": "urn:uuid:32412074-7d7f-4580-bb6b-1a5c4dc77d51",
"request": {
"method": "POST",
"url": "DocumentReference"
},
"resource": {
"resourceType": "DocumentReference",
"id": "f57612d8-4d2d-4c46-aea0-153668842915",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"
]
},
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "32412074-7d7f-4580-bb6b-1a5c4dc77d51"
}
],
"status": "superseded",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
},
"category": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
"code": "clinical-note",
"display": "Clinical Note"
}
]
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"date": "2021-06-20T00:00:00+00:00",
"content": [
{
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
}
]
}
},
{
"fullUrl": "urn:uuid:d81b7e8e-1deb-4849-8632-fbbb377f5342",
"request": {
"method": "POST",
"url": "DocumentReference"
},
"resource": {
"resourceType": "DocumentReference",
"id": "26393ca5-7d21-4e27-88b6-e98f9cd0728d",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"
]
},
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "d81b7e8e-1deb-4849-8632-fbbb377f5342"
}
],
"status": "superseded",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
},
"category": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
"code": "clinical-note",
"display": "Clinical Note"
}
]
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"date": "2024-09-12T00:00:00+00:00",
"content": [
{
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
}
]
}
},
{
"fullUrl": "urn:uuid:08129c91-3a4b-4c4a-9829-86d2a1402d6f",
"request": {
"method": "POST",
"url": "DocumentReference"
},
"resource": {
"resourceType": "DocumentReference",
"id": "7de01e22-1692-4cdd-8b8b-51c3927a1820",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"
]
},
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "08129c91-3a4b-4c4a-9829-86d2a1402d6f"
}
],
"status": "superseded",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
},
"category": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
"code": "clinical-note",
"display": "Clinical Note"
}
]
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"date": "2021-03-28T00:00:00+00:00",
"content": [
{
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
}
]
}
},
{
"fullUrl": "urn:uuid:c7d2bb0f-727c-49bb-af89-487b2bfbf4c2",
"request": {
"method": "POST",
"url": "DocumentReference"
},
"resource": {
"resourceType": "DocumentReference",
"id": "f0e53c0e-6028-4c97-8bed-f3dca694f88b",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"
]
},
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "c7d2bb0f-727c-49bb-af89-487b2bfbf4c2"
}
],
"status": "superseded",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
},
"category": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
"code": "clinical-note",
"display": "Clinical Note"
}
]
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"date": "2021-06-20T00:00:00+00:00",
"content": [
{
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
}
]
}
},
{
"fullUrl": "urn:uuid:23be22b0-7f53-4e49-b2d7-c2799a3b873b",
"request": {
"method": "POST",
"url": "DocumentReference"
},
"resource": {
"resourceType": "DocumentReference",
"id": "68b712e7-93b2-4ad1-90d6-f9c912481f5a",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"
]
},
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "23be22b0-7f53-4e49-b2d7-c2799a3b873b"
}
],
"status": "superseded",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
},
"category": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
"code": "clinical-note",
"display": "Clinical Note"
}
]
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"date": "2021-03-28T00:00:00+00:00",
"content": [
{
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
}
]
}
},
{
"fullUrl": "urn:uuid:6f931919-3224-46ec-b890-27ad5535bf0e",
"request": {
"method": "POST",
"url": "DocumentReference"
},
"resource": {
"resourceType": "DocumentReference",
"id": "4be74984-c229-46cb-9cd3-90d921465160",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"
]
},
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "6f931919-3224-46ec-b890-27ad5535bf0e"
}
],
"status": "superseded",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
},
"category": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
"code": "clinical-note",
"display": "Clinical Note"
}
]
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"date": "2023-03-10T00:00:00+00:00",
"content": [
{
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
}
]
}
},
{
"fullUrl": "urn:uuid:787e5ae2-507b-482a-9f87-94273ef25736",
"request": {
"method": "POST",
"url": "DocumentReference"
},
"resource": {
"resourceType": "DocumentReference",
"id": "4de3bb41-16d0-449e-9f68-db0bf75e671b",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"
]
},
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "787e5ae2-507b-482a-9f87-94273ef25736"
}
],
"status": "superseded",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
},
"category": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
"code": "clinical-note",
"display": "Clinical Note"
}
]
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"date": "2022-06-16T00:00:00+00:00",
"content": [
{
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
}
]
}
},
{
"fullUrl": "urn:uuid:705cbe07-740c-4283-ad37-bc50bc83fbc7",
"request": {
"method": "POST",
"url": "DocumentReference"
},
"resource": {
"resourceType": "DocumentReference",
"id": "46465643-ba44-4e6f-8b55-6da71b656da9",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"
]
},
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "705cbe07-740c-4283-ad37-bc50bc83fbc7"
}
],
"status": "superseded",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
},
"category": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
"code": "clinical-note",
"display": "Clinical Note"
}
]
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"date": "2023-09-14T00:00:00+00:00",
"content": [
{
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
}
]
}
},
{
"fullUrl": "urn:uuid:3d47efa6-fb34-48e3-89a5-a20706e022ea",
"request": {
"method": "POST",
"url": "DocumentReference"
},
"resource": {
"resourceType": "DocumentReference",
"id": "4754d1ce-feae-4af2-bd20-79a476596c54",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"
]
},
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "3d47efa6-fb34-48e3-89a5-a20706e022ea"
}
],
"status": "superseded",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
},
"category": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
"code": "clinical-note",
"display": "Clinical Note"
}
]
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"date": "2024-03-05T00:00:00+00:00",
"content": [
{
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
}
]
}
},
{
"fullUrl": "urn:uuid:88198043-e3eb-4ea0-9194-44d9a809050e",
"request": {
"method": "POST",
"url": "DocumentReference"
},
"resource": {
"resourceType": "DocumentReference",
"id": "ff0e74bb-2f4a-440d-9ac6-ff98c76aa32e",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"
]
},
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "88198043-e3eb-4ea0-9194-44d9a809050e"
}
],
"status": "superseded",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "34117-2",
"display": "History and physical note"
},
{
"system": "http://loinc.org",
"code": "51847-2",
"display": "Evaluation + Plan note"
}
]
},
"category": [
{
"coding": [
{
"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
"code": "clinical-note",
"display": "Clinical Note"
}
]
}
],
"subject": {
"reference": "urn:uuid:b177c416-9498-48f4-a1dd-86646819fe4a"
},
"date": "2025-03-06T00:00:00+00:00",
"content": [
{
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
}
]
}
}
]
}