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| @prefix fhir: <http://hl7.org/fhir/> . | |
| @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> . | |
| @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . | |
| @prefix sct: <http://snomed.info/id#> . | |
| @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . | |
| <urn:uuid:60499a05-b08e-170a-6c0a-a363cb64df9b> | |
| rdf:type fhir:DiagnosticReport ; | |
| fhir:DiagnosticReport.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "LAB" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0074"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "57698-3" ] ; | |
| fhir:Coding.display [ fhir:value "Lipid panel with direct LDL - Serum or Plasma" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Lipid panel with direct LDL - Serum or Plasma" ] | |
| ] ; | |
| fhir:DiagnosticReport.effectiveDateTime | |
| [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] | |
| ] ; | |
| fhir:DiagnosticReport.issued [ fhir:value | |
| "2017-03-31T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.performer | |
| [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Organization?identifier=https://github.com/synthetichealth/synthea|ace1ac31-036a-38fd-b451-b3b87157c717" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.result [ fhir:Reference.display [ fhir:value "Cholesterol [Mass/volume] in Serum or Plasma" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:d7265c0f-a374-4bbb-c650-04bf41099123" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.result [ fhir:Reference.display [ fhir:value "Cholesterol in HDL [Mass/volume] in Serum or Plasma" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:471cba4c-bb13-f20b-e116-1e5788f33a4d" ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:DiagnosticReport.result [ fhir:Reference.display [ fhir:value "Triglycerides" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:de03feaa-7bba-3944-060c-ff94525333f3" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:DiagnosticReport.result [ fhir:Reference.display [ fhir:value "Low Density Lipoprotein Cholesterol" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:2d7011a6-3595-6b55-7f9c-78458f2e06df" ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:DiagnosticReport.status [ fhir:value | |
| "final" ] ; | |
| fhir:DiagnosticReport.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" | |
| ] | |
| ] . | |
| <urn:uuid:24dc0e03-316d-37dc-97a6-345c8415e4c3> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "social-history" ] ; | |
| fhir:Coding.display [ fhir:value "Social history" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "72166-2" ] ; | |
| fhir:Coding.display [ fhir:value "Tobacco smoking status" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Tobacco smoking status" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:9c748b35-c9f0-6c85-47af-4434fa1ba3d1" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value "2023-04-14T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8517006" ] ; | |
| fhir:Coding.display [ fhir:value "Ex-smoker (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Ex-smoker (finding)" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 1 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" | |
| ] ; | |
| fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus" | |
| ] | |
| ] . | |
| <urn:uuid:1fde59ee-e323-a0de-a650-8b324f932158> | |
| rdf:type fhir:ExplanationOfBenefit ; | |
| fhir:DomainResource.contained [ rdf:type fhir:ServiceRequest ; | |
| fhir:Resource.id [ fhir:value | |
| "referral" ] ; | |
| fhir:ServiceRequest.intent [ fhir:value | |
| "order" ] ; | |
| fhir:ServiceRequest.performer [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ServiceRequest.requester [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ServiceRequest.status [ fhir:value | |
| "completed" ] ; | |
| fhir:ServiceRequest.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DomainResource.contained [ rdf:type fhir:Coverage ; | |
| fhir:Coverage.beneficiary [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Coverage.payor [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Coverage.status [ fhir:value "active" ] ; | |
| fhir:Coverage.type [ fhir:CodeableConcept.text [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Resource.id [ fhir:value "coverage" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.billablePeriod | |
| [ fhir:Period.end [ fhir:value "2013-06-09T00:37:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2012-06-09T00:37:48-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam | |
| [ fhir:ExplanationOfBenefit.careTeam.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.role | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "primary" ] ; | |
| fhir:Coding.display [ fhir:value "Primary provider" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claimcareteamrole"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.claim | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:b7dfb97a-baf3-88d2-c06a-500fa0aa9373" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.created | |
| [ fhir:value "2012-06-09T00:37:48-04:00"^^xsd:dateTime ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:9a86ae53-c740-9a87-34d5-b18a7ebe51be" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.facility | |
| [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/identifier/claim-group"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "99999999999" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/clm_id"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "b7dfb97a-baf3-88d2-c06a-500fa0aa9373" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance | |
| [ fhir:ExplanationOfBenefit.insurance.coverage | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:Reference.reference [ fhir:value "#coverage" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance.focal | |
| [ fhir:value true ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurer | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:77edd48d-a4e4-4ab7-6994-392ed3f4344b" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "162673000" ] ; | |
| fhir:Coding.display [ fhir:value "General examination of patient (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "General examination of patient (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2012-06-09T00:37:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2012-06-08T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "73595000" ] ; | |
| fhir:Coding.display [ fhir:value "Stress (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Stress (finding)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2012-06-09T00:37:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2012-06-08T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.outcome | |
| [ fhir:value "complete" ] ; | |
| fhir:ExplanationOfBenefit.patient | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.payment | |
| [ fhir:ExplanationOfBenefit.payment.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 0.0 ] | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.referral | |
| [ fhir:Reference.reference [ fhir:value "#referral" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.status | |
| [ fhir:value "active" ] ; | |
| fhir:ExplanationOfBenefit.total | |
| [ fhir:ExplanationOfBenefit.total.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 1244.88 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.total.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "submitted" ] ; | |
| fhir:Coding.display [ fhir:value "Submitted Amount" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Submitted Amount" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "professional" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.use [ fhir:value | |
| "claim" ] . | |
| <urn:uuid:eddd1caf-e109-e0be-3547-c68fd96855ee> | |
| rdf:type fhir:Condition ; | |
| fhir:Condition.abatementDateTime | |
| [ fhir:value "2024-06-28T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Condition.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "encounter-diagnosis" ] ; | |
| fhir:Coding.display [ fhir:value "Encounter Diagnosis" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Condition.clinicalStatus [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "resolved" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-clinical"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Condition.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "314529007" ] ; | |
| fhir:Coding.display [ fhir:value "Medication review due (situation)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Medication review due (situation)" ] | |
| ] ; | |
| fhir:Condition.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:9c748b35-c9f0-6c85-47af-4434fa1ba3d1" ] | |
| ] ; | |
| fhir:Condition.onsetDateTime [ fhir:value | |
| "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Condition.recordedDate [ fhir:value | |
| "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Condition.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Condition.verificationStatus | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "confirmed" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-ver-status"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" | |
| ] | |
| ] . | |
| <urn:uuid:5a994c26-a4d3-1a7d-c0f8-963c0bf520c9> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "laboratory" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "2093-3" ] ; | |
| fhir:Coding.display [ fhir:value "Cholesterol [Mass/volume] in Serum or Plasma" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Cholesterol [Mass/volume] in Serum or Plasma" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2024-06-28T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:dc45fcbf-ba0f-6398-3e31-3c9af0fb3288" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2024-06-28T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "mg/dL" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "mg/dL" ] ; | |
| fhir:Quantity.value [ fhir:value 128.07 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" | |
| ] | |
| ] . | |
| <urn:uuid:bdc75463-9ba2-f153-2c3d-b3d2abf17f82> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "laboratory" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "2085-9" ] ; | |
| fhir:Coding.display [ fhir:value "Cholesterol in HDL [Mass/volume] in Serum or Plasma" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Cholesterol in HDL [Mass/volume] in Serum or Plasma" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2021-04-09T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "mg/dL" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "mg/dL" ] ; | |
| fhir:Quantity.value [ fhir:value 29.28 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" | |
| ] | |
| ] . | |
| <urn:uuid:0aa9ac2d-6b63-7c8a-e168-9fa26fa95e4a> | |
| rdf:type fhir:Condition ; | |
| fhir:Condition.abatementDateTime | |
| [ fhir:value "2019-04-06T00:34:44-04:00"^^xsd:dateTime ] ; | |
| fhir:Condition.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "encounter-diagnosis" ] ; | |
| fhir:Coding.display [ fhir:value "Encounter Diagnosis" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Condition.clinicalStatus [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "resolved" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-clinical"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Condition.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "73595000" ] ; | |
| fhir:Coding.display [ fhir:value "Stress (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Stress (finding)" ] | |
| ] ; | |
| fhir:Condition.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] | |
| ] ; | |
| fhir:Condition.onsetDateTime [ fhir:value | |
| "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Condition.recordedDate [ fhir:value | |
| "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Condition.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Condition.verificationStatus | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "confirmed" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-ver-status"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" | |
| ] | |
| ] . | |
| <urn:uuid:2f34d3a8-9af2-fbea-9381-f3ea0b5f47d9> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "85354-9" ] ; | |
| fhir:Coding.display [ fhir:value "Blood pressure panel with all children optional" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Blood pressure panel with all children optional" ] | |
| ] ; | |
| fhir:Observation.component [ fhir:Observation.component.code | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8480-6" ] ; | |
| fhir:Coding.display [ fhir:value "Systolic Blood Pressure" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Systolic Blood Pressure" ] | |
| ] ; | |
| fhir:Observation.component.valueQuantity | |
| [ fhir:Quantity.code [ fhir:value "mm[Hg]" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "mm[Hg]" ] ; | |
| fhir:Quantity.value [ fhir:value "145"^^xsd:decimal ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:Observation.component [ fhir:Observation.component.code | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8462-4" ] ; | |
| fhir:Coding.display [ fhir:value "Diastolic Blood Pressure" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Diastolic Blood Pressure" ] | |
| ] ; | |
| fhir:Observation.component.valueQuantity | |
| [ fhir:Quantity.code [ fhir:value "mm[Hg]" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "mm[Hg]" ] ; | |
| fhir:Quantity.value [ fhir:value "84"^^xsd:decimal ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value "2017-03-31T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" | |
| ] | |
| ] . | |
| <urn:uuid:8ea3c68f-e8c2-a549-7006-24ed10c44212> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "39156-5" ] ; | |
| fhir:Coding.display [ fhir:value "Body mass index (BMI) [Ratio]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Body mass index (BMI) [Ratio]" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2019-04-05T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f466d2cb-3b48-2fe4-99dd-2e31fee1e1b8" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2019-04-05T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "kg/m2" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "kg/m2" ] ; | |
| fhir:Quantity.value [ fhir:value 27.84 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" | |
| ] | |
| ] . | |
| <urn:uuid:38cb4739-7772-114e-6e7b-21ac4b1c2e33> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "laboratory" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "777-3" ] ; | |
| fhir:Coding.display [ fhir:value "Platelets [#/volume] in Blood by Automated count" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Platelets [#/volume] in Blood by Automated count" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2015-03-27T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:e0623eab-bc78-461e-cb51-4cdf6916360e" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2015-03-27T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "10*3/uL" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "10*3/uL" ] ; | |
| fhir:Quantity.value [ fhir:value 183.26 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" | |
| ] | |
| ] . | |
| <urn:uuid:4b5f69fb-f3a7-07f6-b476-1ad9fbce6381> | |
| rdf:type fhir:Encounter ; | |
| fhir:Encounter.class [ fhir:Coding.code [ fhir:value "AMB" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] | |
| ] ; | |
| fhir:Encounter.identifier [ fhir:Identifier.system [ fhir:value "https://github.com/synthetichealth/synthea"^^xsd:anyURI ] ; | |
| fhir:Identifier.use [ fhir:value "official" ] ; | |
| fhir:Identifier.value [ fhir:value "4b5f69fb-f3a7-07f6-b476-1ad9fbce6381" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Encounter.location [ fhir:Encounter.location.location | |
| [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Encounter.participant [ fhir:Encounter.participant.individual | |
| [ fhir:Reference.display [ fhir:value "Dr. Alejandra902 Thompson596" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:Encounter.participant.period | |
| [ fhir:Period.end [ fhir:value "1993-05-15T00:19:44-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "1993-05-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Encounter.participant.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "PPRF" ] ; | |
| fhir:Coding.display [ fhir:value "primary performer" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ParticipationType"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "primary performer" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Encounter.period [ fhir:Period.end [ fhir:value "1993-05-15T00:19:44-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "1993-05-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Encounter.serviceProvider [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Organization?identifier=https://github.com/synthetichealth/synthea|ace1ac31-036a-38fd-b451-b3b87157c717" ] | |
| ] ; | |
| fhir:Encounter.status [ fhir:value | |
| "finished" ] ; | |
| fhir:Encounter.subject [ fhir:Reference.display [ fhir:value "Mr. Darrick836 Bennett146 Wunsch504" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Encounter.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "162673000" ] ; | |
| fhir:Coding.display [ fhir:value "General examination of patient (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "General examination of patient (procedure)" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" | |
| ] | |
| ] . | |
| <urn:uuid:c7dc0429-3424-de5e-43f1-847f7baf79c2> | |
| rdf:type fhir:ExplanationOfBenefit ; | |
| fhir:DomainResource.contained [ rdf:type fhir:ServiceRequest ; | |
| fhir:Resource.id [ fhir:value | |
| "referral" ] ; | |
| fhir:ServiceRequest.intent [ fhir:value | |
| "order" ] ; | |
| fhir:ServiceRequest.performer [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ServiceRequest.requester [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ServiceRequest.status [ fhir:value | |
| "completed" ] ; | |
| fhir:ServiceRequest.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DomainResource.contained [ rdf:type fhir:Coverage ; | |
| fhir:Coverage.beneficiary [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Coverage.payor [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Coverage.status [ fhir:value "active" ] ; | |
| fhir:Coverage.type [ fhir:CodeableConcept.text [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Resource.id [ fhir:value "coverage" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.billablePeriod | |
| [ fhir:Period.end [ fhir:value "2018-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam | |
| [ fhir:ExplanationOfBenefit.careTeam.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.role | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "primary" ] ; | |
| fhir:Coding.display [ fhir:value "Primary provider" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claimcareteamrole"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.claim | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:6dcb817f-e49d-601a-0d39-b042ce75f981" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.created | |
| [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:d22ccd96-ed30-05f1-2492-cd708d980cf2" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:0aa9ac2d-6b63-7c8a-e168-9fa26fa95e4a" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.facility | |
| [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/clm_id"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "6dcb817f-e49d-601a-0d39-b042ce75f981" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/identifier/claim-group"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "99999999999" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance | |
| [ fhir:ExplanationOfBenefit.insurance.coverage | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:Reference.reference [ fhir:value "#coverage" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance.focal | |
| [ fhir:value true ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurer | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "73595000" ] ; | |
| fhir:Coding.display [ fhir:value "Stress (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Stress (finding)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "8" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 7 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 14.916 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 59.664 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "5" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "76499-3" ] ; | |
| fhir:Coding.display [ fhir:value "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "10" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 9 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "428211000124100" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of substance use (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of substance use (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "14" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 13 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "454711000124102" ] ; | |
| fhir:Coding.display [ fhir:value "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:Coding.version [ fhir:value "http://snomed.info/sct/731000124108" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "12" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 11 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 27.200000000000003 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 108.80000000000001 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "140" ] ; | |
| fhir:Coding.display [ fhir:value "Influenza, seasonal, injectable, preservative free" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/cvx"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Influenza, seasonal, injectable, preservative free" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 14.916 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 59.664 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "7" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "72109-2" ] ; | |
| fhir:Coding.display [ fhir:value "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "16" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 15 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "171207006" ] ; | |
| fhir:Coding.display [ fhir:value "Depression screening (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Depression screening (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "11" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 10 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 14.916 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 59.664 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "6" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "55757-9" ] ; | |
| fhir:Coding.display [ fhir:value "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "13" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 12 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "763302001" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "15" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 14 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "866148006" ] ; | |
| fhir:Coding.display [ fhir:value "Screening for domestic abuse (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Screening for domestic abuse (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "9" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 8 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "710824005" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of health and social care needs (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of health and social care needs (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "7" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 6 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "162673000" ] ; | |
| fhir:Coding.display [ fhir:value "General examination of patient (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "General examination of patient (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "314529007" ] ; | |
| fhir:Coding.display [ fhir:value "Medication review due (situation)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Medication review due (situation)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "5" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 59.664 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 14.916 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "4" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "57698-3" ] ; | |
| fhir:Coding.display [ fhir:value "Lipid panel with direct LDL - Serum or Plasma" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Lipid panel with direct LDL - Serum or Plasma" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "6" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 108.80000000000001 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 27.200000000000003 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "113" ] ; | |
| fhir:Coding.display [ fhir:value "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/cvx"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "3" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 27.200000000000003 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 108.80000000000001 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "3" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "52" ] ; | |
| fhir:Coding.display [ fhir:value "Hep A, adult" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/cvx"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Hep A, adult" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "4" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.outcome | |
| [ fhir:value "complete" ] ; | |
| fhir:ExplanationOfBenefit.patient | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.payment | |
| [ fhir:ExplanationOfBenefit.payment.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 2635.7760000000003 ] | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.referral | |
| [ fhir:Reference.reference [ fhir:value "#referral" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.status | |
| [ fhir:value "active" ] ; | |
| fhir:ExplanationOfBenefit.total | |
| [ fhir:ExplanationOfBenefit.total.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 1050.78 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.total.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "submitted" ] ; | |
| fhir:Coding.display [ fhir:value "Submitted Amount" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Submitted Amount" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "professional" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.use [ fhir:value | |
| "claim" ] . | |
| <urn:uuid:ae29a2de-0046-d9bc-c124-b714c73f3118> | |
| rdf:type fhir:ExplanationOfBenefit ; | |
| fhir:DomainResource.contained [ rdf:type fhir:ServiceRequest ; | |
| fhir:Resource.id [ fhir:value | |
| "referral" ] ; | |
| fhir:ServiceRequest.intent [ fhir:value | |
| "order" ] ; | |
| fhir:ServiceRequest.performer [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ServiceRequest.requester [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ServiceRequest.status [ fhir:value | |
| "completed" ] ; | |
| fhir:ServiceRequest.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DomainResource.contained [ rdf:type fhir:Coverage ; | |
| fhir:Coverage.beneficiary [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Coverage.payor [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Coverage.status [ fhir:value "active" ] ; | |
| fhir:Coverage.type [ fhir:CodeableConcept.text [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Resource.id [ fhir:value "coverage" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.billablePeriod | |
| [ fhir:Period.end [ fhir:value "2024-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam | |
| [ fhir:ExplanationOfBenefit.careTeam.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.role | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "primary" ] ; | |
| fhir:Coding.display [ fhir:value "Primary provider" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claimcareteamrole"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.claim | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:4547b32e-3a70-d01c-e82a-0015df42d27d" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.created | |
| [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:eddd1caf-e109-e0be-3547-c68fd96855ee" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:cba0d9ee-abc7-759d-519d-4a5e3252cce1" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.facility | |
| [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/clm_id"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "4547b32e-3a70-d01c-e82a-0015df42d27d" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/identifier/claim-group"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "99999999999" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance | |
| [ fhir:ExplanationOfBenefit.insurance.coverage | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:Reference.reference [ fhir:value "#coverage" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance.focal | |
| [ fhir:value true ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurer | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "428211000124100" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of substance use (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of substance use (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "6" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "314529007" ] ; | |
| fhir:Coding.display [ fhir:value "Medication review due (situation)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Medication review due (situation)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "3" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "160903007" ] ; | |
| fhir:Coding.display [ fhir:value "Full-time employment (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Full-time employment (finding)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "5" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "713106006" ] ; | |
| fhir:Coding.display [ fhir:value "Screening for drug abuse (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Screening for drug abuse (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "7" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 6 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "710824005" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of health and social care needs (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of health and social care needs (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "4" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:9c748b35-c9f0-6c85-47af-4434fa1ba3d1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "162673000" ] ; | |
| fhir:Coding.display [ fhir:value "General examination of patient (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "General examination of patient (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 59.664 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 14.916 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "82666-9" ] ; | |
| fhir:Coding.display [ fhir:value "Drug Abuse Screening Test-10 [DAST-10]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Drug Abuse Screening Test-10 [DAST-10]" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "8" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 7 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 108.80000000000001 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 27.200000000000003 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "140" ] ; | |
| fhir:Coding.display [ fhir:value "Influenza, seasonal, injectable, preservative free" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/cvx"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Influenza, seasonal, injectable, preservative free" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.outcome | |
| [ fhir:value "complete" ] ; | |
| fhir:ExplanationOfBenefit.patient | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.payment | |
| [ fhir:ExplanationOfBenefit.payment.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 1203.8239999999998 ] | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.referral | |
| [ fhir:Reference.reference [ fhir:value "#referral" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.status | |
| [ fhir:value "active" ] ; | |
| fhir:ExplanationOfBenefit.total | |
| [ fhir:ExplanationOfBenefit.total.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 704.20 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.total.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "submitted" ] ; | |
| fhir:Coding.display [ fhir:value "Submitted Amount" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Submitted Amount" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "professional" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.use [ fhir:value | |
| "claim" ] . | |
| <urn:uuid:decab121-fbfe-e77c-6020-7451a18fc72c> | |
| rdf:type fhir:Procedure ; | |
| fhir:Procedure.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "312681000" ] ; | |
| fhir:Coding.display [ fhir:value "Bone density scan (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Bone density scan (procedure)" ] | |
| ] ; | |
| fhir:Procedure.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:0d7f9a4e-58f4-4ac4-9824-2d8ff5c98e5a" ] | |
| ] ; | |
| fhir:Procedure.location [ fhir:Reference.display [ fhir:value "RECUPERATIVE SERVICES UNIT-HEBREW REHAB CENTER" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|cb8fd45a-2e3a-34f7-9552-dddb7c246cef" ] | |
| ] ; | |
| fhir:Procedure.performedPeriod [ fhir:Period.end [ fhir:value "2022-11-10T00:41:56-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2022-11-10T00:26:56-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Procedure.reasonReference [ fhir:Reference.display [ fhir:value "Fracture of clavicle" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:59e99f19-2a84-b008-61b3-cb369b2d1077" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Procedure.status [ fhir:value | |
| "completed" ] ; | |
| fhir:Procedure.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" | |
| ] | |
| ] . | |
| <urn:uuid:51a3c3d4-78fb-fbc6-2a90-56d6d86c0670> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "laboratory" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "6690-2" ] ; | |
| fhir:Coding.display [ fhir:value "Leukocytes [#/volume] in Blood by Automated count" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Leukocytes [#/volume] in Blood by Automated count" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2015-03-27T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:e0623eab-bc78-461e-cb51-4cdf6916360e" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2015-03-27T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "10*3/uL" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "10*3/uL" ] ; | |
| fhir:Quantity.value [ fhir:value 6.1946 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" | |
| ] | |
| ] . | |
| <urn:uuid:06ff8d4d-6cc6-0a52-7842-f9bceeb97831> | |
| rdf:type fhir:ExplanationOfBenefit ; | |
| fhir:DomainResource.contained [ rdf:type fhir:ServiceRequest ; | |
| fhir:Resource.id [ fhir:value | |
| "referral" ] ; | |
| fhir:ServiceRequest.intent [ fhir:value | |
| "order" ] ; | |
| fhir:ServiceRequest.performer [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883090" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ServiceRequest.requester [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883090" ] | |
| ] ; | |
| fhir:ServiceRequest.status [ fhir:value | |
| "completed" ] ; | |
| fhir:ServiceRequest.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DomainResource.contained [ rdf:type fhir:Coverage ; | |
| fhir:Coverage.beneficiary [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Coverage.payor [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Coverage.status [ fhir:value "active" ] ; | |
| fhir:Coverage.type [ fhir:CodeableConcept.text [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Resource.id [ fhir:value "coverage" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.billablePeriod | |
| [ fhir:Period.end [ fhir:value "2016-08-24T00:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2015-08-24T00:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam | |
| [ fhir:ExplanationOfBenefit.careTeam.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883090" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.role | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "primary" ] ; | |
| fhir:Coding.display [ fhir:value "Primary provider" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claimcareteamrole"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.claim | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:5f26b0b0-6383-25ed-000d-b0819db46fd1" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.created | |
| [ fhir:value "2015-08-24T00:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:619b30e1-3d25-f020-6ac2-c0c42081ffe0" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:b0a12816-e320-cf4b-a8f6-7ed4bdf27c68" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.facility | |
| [ fhir:Reference.display [ fhir:value "RECUPERATIVE SERVICES UNIT-HEBREW REHAB CENTER" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|cb8fd45a-2e3a-34f7-9552-dddb7c246cef" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/clm_id"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "5f26b0b0-6383-25ed-000d-b0819db46fd1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/identifier/claim-group"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "99999999999" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance | |
| [ fhir:ExplanationOfBenefit.insurance.coverage | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:Reference.reference [ fhir:value "#coverage" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance.focal | |
| [ fhir:value true ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurer | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "20" ] ; | |
| fhir:Coding.display [ fhir:value "Urgent Care Facility" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "370247008" ] ; | |
| fhir:Coding.display [ fhir:value "Facial laceration" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Facial laceration" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "3" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2015-08-24T00:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2015-08-23T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "20" ] ; | |
| fhir:Coding.display [ fhir:value "Urgent Care Facility" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "312608009" ] ; | |
| fhir:Coding.display [ fhir:value "Laceration - injury (disorder)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Laceration - injury (disorder)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2015-08-24T00:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2015-08-23T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:a2a0afbe-5c77-c45a-7fcd-e62cc76d2a9d" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "20" ] ; | |
| fhir:Coding.display [ fhir:value "Urgent Care Facility" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "50849002" ] ; | |
| fhir:Coding.display [ fhir:value "Emergency room admission (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Emergency room admission (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2015-08-24T00:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2015-08-23T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 1343.964 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 5375.856 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 6719.82 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 6719.82 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "20" ] ; | |
| fhir:Coding.display [ fhir:value "Urgent Care Facility" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 6719.82 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "288086009" ] ; | |
| fhir:Coding.display [ fhir:value "Suture open wound" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Suture open wound" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "4" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2015-08-24T00:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2015-08-23T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.outcome | |
| [ fhir:value "complete" ] ; | |
| fhir:ExplanationOfBenefit.patient | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.payment | |
| [ fhir:ExplanationOfBenefit.payment.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 5375.856 ] | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883090" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.referral | |
| [ fhir:Reference.reference [ fhir:value "#referral" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.status | |
| [ fhir:value "active" ] ; | |
| fhir:ExplanationOfBenefit.total | |
| [ fhir:ExplanationOfBenefit.total.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 6866.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.total.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "submitted" ] ; | |
| fhir:Coding.display [ fhir:value "Submitted Amount" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Submitted Amount" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "institutional" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.use [ fhir:value | |
| "claim" ] . | |
| <urn:uuid:72bae2df-678a-ede4-8174-67162e81bdbd> | |
| rdf:type fhir:DocumentReference ; | |
| fhir:DocumentReference.author [ fhir:Reference.display [ fhir:value "Dr. Alejandra902 Thompson596" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "clinical-note" ] ; | |
| fhir:Coding.display [ fhir:value "Clinical Note" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.content [ fhir:DocumentReference.content.attachment | |
| [ fhir:Attachment.contentType [ fhir:value | |
| "text/plain; charset=utf-8" ] ; | |
| fhir:Attachment.data [ fhir:value | |
| "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" ] | |
| ] ; | |
| fhir:DocumentReference.content.format | |
| [ fhir:Coding.code [ fhir:value "urn:ihe:iti:xds:2017:mimeTypeSufficient" ] ; | |
| fhir:Coding.display [ fhir:value "mimeType Sufficient" ] ; | |
| fhir:Coding.system [ fhir:value "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode"^^xsd:anyURI ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.context [ fhir:DocumentReference.context.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:9c748b35-c9f0-6c85-47af-4434fa1ba3d1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.context.period | |
| [ fhir:Period.end [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] | |
| ] ; | |
| fhir:DocumentReference.custodian | |
| [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Organization?identifier=https://github.com/synthetichealth/synthea|ace1ac31-036a-38fd-b451-b3b87157c717" ] | |
| ] ; | |
| fhir:DocumentReference.date [ fhir:value | |
| "2023-04-14T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DocumentReference.identifier | |
| [ fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "urn:uuid:f11c304f-0131-eb8e-97f5-0f28fc53c2bf" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.status [ fhir:value | |
| "superseded" ] ; | |
| fhir:DocumentReference.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:DocumentReference.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" | |
| ] | |
| ] . | |
| <urn:uuid:6dcb817f-e49d-601a-0d39-b042ce75f981> | |
| rdf:type fhir:Claim ; | |
| fhir:Claim.billablePeriod [ fhir:Period.end [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Claim.created [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Claim.diagnosis [ fhir:Claim.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:0aa9ac2d-6b63-7c8a-e168-9fa26fa95e4a" ] | |
| ] ; | |
| fhir:Claim.diagnosis.sequence [ fhir:value | |
| "2" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:Claim.diagnosis [ fhir:Claim.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:d22ccd96-ed30-05f1-2492-cd708d980cf2" ] | |
| ] ; | |
| fhir:Claim.diagnosis.sequence [ fhir:value | |
| "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.facility [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:Claim.insurance [ fhir:Claim.insurance.coverage [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Claim.insurance.focal [ fhir:value | |
| true ] ; | |
| fhir:Claim.insurance.sequence [ fhir:value | |
| "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:Claim.item.procedureSequence | |
| [ fhir:index 0 ; | |
| fhir:value "3" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "171207006" ] ; | |
| fhir:Coding.display [ fhir:value "Depression screening (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Depression screening (procedure)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "11" ] ; | |
| fhir:index 10 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:Claim.item.procedureSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "710824005" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of health and social care needs (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of health and social care needs (procedure)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "7" ] ; | |
| fhir:index 6 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "73595000" ] ; | |
| fhir:Coding.display [ fhir:value "Stress (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Stress (finding)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "8" ] ; | |
| fhir:index 7 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "314529007" ] ; | |
| fhir:Coding.display [ fhir:value "Medication review due (situation)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Medication review due (situation)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "5" ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:Claim.item.procedureSequence | |
| [ fhir:index 0 ; | |
| fhir:value "6" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "763302001" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "15" ] ; | |
| fhir:index 14 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "4" | |
| ] ; | |
| fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "57698-3" ] ; | |
| fhir:Coding.display [ fhir:value "Lipid panel with direct LDL - Serum or Plasma" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Lipid panel with direct LDL - Serum or Plasma" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "6" ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "7" | |
| ] ; | |
| fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "72109-2" ] ; | |
| fhir:Coding.display [ fhir:value "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "16" ] ; | |
| fhir:index 15 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "162673000" ] ; | |
| fhir:Coding.display [ fhir:value "General examination of patient (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "General examination of patient (procedure)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "3" | |
| ] ; | |
| fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "52" ] ; | |
| fhir:Coding.display [ fhir:value "Hep A, adult" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/cvx"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Hep A, adult" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "4" ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:Claim.item.procedureSequence | |
| [ fhir:index 0 ; | |
| fhir:value "5" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "428211000124100" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of substance use (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of substance use (procedure)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "14" ] ; | |
| fhir:index 13 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:Claim.item.procedureSequence | |
| [ fhir:index 0 ; | |
| fhir:value "4" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "454711000124102" ] ; | |
| fhir:Coding.display [ fhir:value "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:Coding.version [ fhir:value "http://snomed.info/sct/731000124108" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "12" ] ; | |
| fhir:index 11 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "5" | |
| ] ; | |
| fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "76499-3" ] ; | |
| fhir:Coding.display [ fhir:value "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "10" ] ; | |
| fhir:index 9 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "6" | |
| ] ; | |
| fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "55757-9" ] ; | |
| fhir:Coding.display [ fhir:value "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "13" ] ; | |
| fhir:index 12 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "113" ] ; | |
| fhir:Coding.display [ fhir:value "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/cvx"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "3" ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "140" ] ; | |
| fhir:Coding.display [ fhir:value "Influenza, seasonal, injectable, preservative free" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/cvx"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Influenza, seasonal, injectable, preservative free" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "2" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:Claim.item.procedureSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "866148006" ] ; | |
| fhir:Coding.display [ fhir:value "Screening for domestic abuse (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Screening for domestic abuse (procedure)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "9" ] ; | |
| fhir:index 8 | |
| ] ; | |
| fhir:Claim.patient [ fhir:Reference.display [ fhir:value "Darrick836 Wunsch504" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Claim.priority [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "normal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.procedure [ fhir:Claim.procedure.procedureReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:958cd50d-1085-9dc4-b1ac-d7665b9335da" ] | |
| ] ; | |
| fhir:Claim.procedure.sequence [ fhir:value | |
| "5" ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:Claim.procedure [ fhir:Claim.procedure.procedureReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:1d0baedf-44d1-e96c-b49a-4c72ea52e997" ] | |
| ] ; | |
| fhir:Claim.procedure.sequence [ fhir:value | |
| "3" ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:Claim.procedure [ fhir:Claim.procedure.procedureReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:b6e60da1-85d4-01ae-6031-534d70158497" ] | |
| ] ; | |
| fhir:Claim.procedure.sequence [ fhir:value | |
| "2" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:Claim.procedure [ fhir:Claim.procedure.procedureReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:f73c41a1-7e4e-f664-3459-0e466be37ac3" ] | |
| ] ; | |
| fhir:Claim.procedure.sequence [ fhir:value | |
| "6" ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:Claim.procedure [ fhir:Claim.procedure.procedureReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:434b93fc-d7b9-d315-d888-94d6293495f5" ] | |
| ] ; | |
| fhir:Claim.procedure.sequence [ fhir:value | |
| "4" ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:Claim.procedure [ fhir:Claim.procedure.procedureReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:7785362a-9c87-1886-e80c-fc5a67859165" ] | |
| ] ; | |
| fhir:Claim.procedure.sequence [ fhir:value | |
| "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.provider [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Organization?identifier=https://github.com/synthetichealth/synthea|ace1ac31-036a-38fd-b451-b3b87157c717" ] | |
| ] ; | |
| fhir:Claim.status [ fhir:value "active" ] ; | |
| fhir:Claim.supportingInfo [ fhir:Claim.supportingInfo.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "info" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.supportingInfo.sequence | |
| [ fhir:value "7" ] ; | |
| fhir:index 6 | |
| ] ; | |
| fhir:Claim.supportingInfo [ fhir:Claim.supportingInfo.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "info" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.supportingInfo.sequence | |
| [ fhir:value "4" ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:Claim.supportingInfo [ fhir:Claim.supportingInfo.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "info" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.supportingInfo.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:Claim.supportingInfo.valueReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:c6311832-70a0-0516-fd15-104cf9741554" ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:Claim.supportingInfo [ fhir:Claim.supportingInfo.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "info" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.supportingInfo.sequence | |
| [ fhir:value "6" ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:Claim.supportingInfo [ fhir:Claim.supportingInfo.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "info" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.supportingInfo.sequence | |
| [ fhir:value "5" ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:Claim.supportingInfo [ fhir:Claim.supportingInfo.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "info" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.supportingInfo.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:Claim.supportingInfo.valueReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:188de3d3-484a-cc06-06fc-a1f2f6fddcf4" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.supportingInfo [ fhir:Claim.supportingInfo.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "info" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.supportingInfo.sequence | |
| [ fhir:value "3" ] ; | |
| fhir:Claim.supportingInfo.valueReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:6e8210a2-215e-6598-fcb1-e31753a95f0e" ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:Claim.total [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 1050.78 ] | |
| ] ; | |
| fhir:Claim.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "professional" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.use [ fhir:value "claim" ] . | |
| <urn:uuid:07c8eb15-4bfe-8a1c-b462-d1c14cbca4e4> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "survey" ] ; | |
| fhir:Coding.display [ fhir:value "Survey" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "75626-2" ] ; | |
| fhir:Coding.display [ fhir:value "Total score [AUDIT-C]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Total score [AUDIT-C]" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2017-04-01T02:27:51-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2017-04-01T02:27:51.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "{score}" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "{score}" ] ; | |
| fhir:Quantity.value [ fhir:value "3"^^xsd:decimal ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" | |
| ] | |
| ] . | |
| <urn:uuid:9beb0c37-96a8-23b0-ff9f-cc9d0adcbf35> | |
| rdf:type fhir:Procedure ; | |
| fhir:Procedure.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "713106006" ] ; | |
| fhir:Coding.display [ fhir:value "Screening for drug abuse (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Screening for drug abuse (procedure)" ] | |
| ] ; | |
| fhir:Procedure.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:e0623eab-bc78-461e-cb51-4cdf6916360e" ] | |
| ] ; | |
| fhir:Procedure.location [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:Procedure.performedPeriod [ fhir:Period.end [ fhir:value "2015-03-28T02:40:39-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2015-03-28T02:11:04-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Procedure.status [ fhir:value | |
| "completed" ] ; | |
| fhir:Procedure.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" | |
| ] | |
| ] . | |
| <urn:uuid:92dd9f55-1b84-473c-0213-75d9445d6783> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "laboratory" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "789-8" ] ; | |
| fhir:Coding.display [ fhir:value "Erythrocytes [#/volume] in Blood by Automated count" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Erythrocytes [#/volume] in Blood by Automated count" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2015-03-27T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:e0623eab-bc78-461e-cb51-4cdf6916360e" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2015-03-27T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "10*6/uL" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "10*6/uL" ] ; | |
| fhir:Quantity.value [ fhir:value 5.1411 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" | |
| ] | |
| ] . | |
| <urn:uuid:d3188aa2-a587-e899-1520-12727228c072> | |
| rdf:type fhir:Claim ; | |
| fhir:Claim.billablePeriod [ fhir:Period.end [ fhir:value "2024-06-29T00:29:50-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2024-06-28T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Claim.created [ fhir:value "2024-06-29T00:29:50-04:00"^^xsd:dateTime ] ; | |
| fhir:Claim.facility [ fhir:Reference.display [ fhir:value "DEDHAM MEDICAL ASSOCIATES URGENT CARE CENTER LLC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|947c0d4f-3fa0-345a-a4aa-f193ae424571" ] | |
| ] ; | |
| fhir:Claim.insurance [ fhir:Claim.insurance.coverage [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Claim.insurance.focal [ fhir:value | |
| true ] ; | |
| fhir:Claim.insurance.sequence [ fhir:value | |
| "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "140" ] ; | |
| fhir:Coding.display [ fhir:value "Influenza, seasonal, injectable, preservative free" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/cvx"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Influenza, seasonal, injectable, preservative free" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "2" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 356.65 ] | |
| ] ; | |
| fhir:Claim.item.procedureSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "430193006" ] ; | |
| fhir:Coding.display [ fhir:value "Medication Reconciliation (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Medication Reconciliation (procedure)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "3" ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:Claim.item.procedureSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "710824005" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of health and social care needs (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of health and social care needs (procedure)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "5" ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "57698-3" ] ; | |
| fhir:Coding.display [ fhir:value "Lipid panel with direct LDL - Serum or Plasma" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Lipid panel with direct LDL - Serum or Plasma" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "4" ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:dc45fcbf-ba0f-6398-3e31-3c9af0fb3288" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "702927004" ] ; | |
| fhir:Coding.display [ fhir:value "Urgent care clinic (environment)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Urgent care clinic (environment)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.patient [ fhir:Reference.display [ fhir:value "Darrick836 Wunsch504" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Claim.priority [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "normal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.procedure [ fhir:Claim.procedure.procedureReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:c1d29791-bd27-cec5-4b1b-1c0c3a5d4aa1" ] | |
| ] ; | |
| fhir:Claim.procedure.sequence [ fhir:value | |
| "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.procedure [ fhir:Claim.procedure.procedureReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:70e257db-6cc3-687a-7b62-d100597349ba" ] | |
| ] ; | |
| fhir:Claim.procedure.sequence [ fhir:value | |
| "2" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:Claim.provider [ fhir:Reference.display [ fhir:value "DEDHAM MEDICAL ASSOCIATES URGENT CARE CENTER LLC" ] ; | |
| fhir:Reference.reference [ fhir:value "Organization?identifier=https://github.com/synthetichealth/synthea|04b252db-4231-3cb5-963d-6f096fb4b97c" ] | |
| ] ; | |
| fhir:Claim.status [ fhir:value "active" ] ; | |
| fhir:Claim.supportingInfo [ fhir:Claim.supportingInfo.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "info" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.supportingInfo.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:Claim.supportingInfo [ fhir:Claim.supportingInfo.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "info" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.supportingInfo.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:Claim.supportingInfo.valueReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:43004b09-2021-76f4-bc5c-0645a2194aaf" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.total [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 1141.21 ] | |
| ] ; | |
| fhir:Claim.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "professional" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.use [ fhir:value "claim" ] . | |
| <urn:uuid:bc4ddb26-8da1-dec4-1d9b-8ce441982273> | |
| rdf:type fhir:DiagnosticReport ; | |
| fhir:DiagnosticReport.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:DiagnosticReport.effectiveDateTime | |
| [ fhir:value "1993-05-14T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:4b5f69fb-f3a7-07f6-b476-1ad9fbce6381" ] | |
| ] ; | |
| fhir:DiagnosticReport.issued [ fhir:value | |
| "1993-05-14T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.performer | |
| [ fhir:Reference.display [ fhir:value "Dr. Alejandra902 Thompson596" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.presentedForm | |
| [ fhir:Attachment.contentType [ fhir:value | |
| "text/plain; charset=utf-8" ] ; | |
| fhir:Attachment.data [ fhir:value | |
| "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" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.status [ fhir:value | |
| "final" ] ; | |
| fhir:DiagnosticReport.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" | |
| ] | |
| ] . | |
| <urn:uuid:5e60a13d-dc43-365b-a6eb-8139020ddcf1> | |
| rdf:type fhir:MedicationRequest ; | |
| fhir:MedicationRequest.authoredOn | |
| [ fhir:value "2022-11-10T00:26:56-05:00"^^xsd:dateTime ] ; | |
| fhir:MedicationRequest.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "community" ] ; | |
| fhir:Coding.display [ fhir:value "Community" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/medicationrequest-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Community" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:MedicationRequest.dosageInstruction | |
| [ fhir:Dosage.asNeededBoolean [ fhir:value | |
| false ] ; | |
| fhir:Dosage.doseAndRate [ fhir:Dosage.doseAndRate.doseQuantity | |
| [ fhir:Quantity.value [ fhir:value 1.0 ] | |
| ] ; | |
| fhir:Dosage.doseAndRate.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "ordered" ] ; | |
| fhir:Coding.display [ fhir:value "Ordered" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/dose-rate-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Dosage.sequence [ fhir:value | |
| "1" ] ; | |
| fhir:Dosage.timing [ fhir:Timing.repeat [ fhir:Timing.repeat.frequency [ fhir:value | |
| "1" ] ; | |
| fhir:Timing.repeat.period [ fhir:value | |
| 6.0 ] ; | |
| fhir:Timing.repeat.periodUnit [ fhir:value | |
| "h" ] | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:MedicationRequest.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:0d7f9a4e-58f4-4ac4-9824-2d8ff5c98e5a" ] | |
| ] ; | |
| fhir:MedicationRequest.intent [ fhir:value | |
| "order" ] ; | |
| fhir:MedicationRequest.medicationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1049221" ] ; | |
| fhir:Coding.display [ fhir:value "Acetaminophen 325 MG / oxyCODONE Hydrochloride 5 MG Oral Tablet" ] ; | |
| fhir:Coding.system [ fhir:value "http://www.nlm.nih.gov/research/umls/rxnorm"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Acetaminophen 325 MG / oxyCODONE Hydrochloride 5 MG Oral Tablet" ] | |
| ] ; | |
| fhir:MedicationRequest.requester | |
| [ fhir:Reference.display [ fhir:value "Dr. Emma804 Larkin917" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883090" ] | |
| ] ; | |
| fhir:MedicationRequest.status [ fhir:value | |
| "stopped" ] ; | |
| fhir:MedicationRequest.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" | |
| ] | |
| ] . | |
| <urn:uuid:212b7e36-784f-02d8-7759-e63ad6d6d89d> | |
| rdf:type fhir:Condition ; | |
| fhir:Condition.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "encounter-diagnosis" ] ; | |
| fhir:Coding.display [ fhir:value "Encounter Diagnosis" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Condition.clinicalStatus [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "active" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-clinical"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Condition.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "703151001" ] ; | |
| fhir:Coding.display [ fhir:value "History of single seizure (situation)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "History of single seizure (situation)" ] | |
| ] ; | |
| fhir:Condition.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:0c18d692-5847-6776-6ef8-a9acaf4cbbb4" ] | |
| ] ; | |
| fhir:Condition.onsetDateTime [ fhir:value | |
| "1983-05-17T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Condition.recordedDate [ fhir:value | |
| "1983-05-17T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Condition.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Condition.verificationStatus | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "confirmed" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-ver-status"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" | |
| ] | |
| ] . | |
| <urn:uuid:632b4118-074e-0d73-b0ca-46bd46d2f7a6> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "laboratory" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "785-6" ] ; | |
| fhir:Coding.display [ fhir:value "MCH [Entitic mass] by Automated count" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "MCH [Entitic mass] by Automated count" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2021-04-09T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "pg" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "pg" ] ; | |
| fhir:Quantity.value [ fhir:value 31.217 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" | |
| ] | |
| ] . | |
| <urn:uuid:ad94ff21-f175-1622-bbc9-bcb44c875cde> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "72514-3" ] ; | |
| fhir:Coding.display [ fhir:value "Pain severity - 0-10 verbal numeric rating [Score] - Reported" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Pain severity - 0-10 verbal numeric rating [Score] - Reported" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2019-04-05T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f466d2cb-3b48-2fe4-99dd-2e31fee1e1b8" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2019-04-05T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "{score}" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "{score}" ] ; | |
| fhir:Quantity.value [ fhir:value "3"^^xsd:decimal ] | |
| ] . | |
| <urn:uuid:595a329a-8a0b-d2bb-a802-9052445000d7> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "9279-1" ] ; | |
| fhir:Coding.display [ fhir:value "Respiratory rate" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Respiratory rate" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:9c748b35-c9f0-6c85-47af-4434fa1ba3d1" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2023-04-14T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "/min" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "/min" ] ; | |
| fhir:Quantity.value [ fhir:value "12"^^xsd:decimal ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" | |
| ] | |
| ] . | |
| <urn:uuid:73bc311e-6a63-e239-7bdd-db07f3e656c0> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "survey" ] ; | |
| fhir:Coding.display [ fhir:value "Survey" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "55758-7" ] ; | |
| fhir:Coding.display [ fhir:value "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2019-04-06T01:53:58-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f466d2cb-3b48-2fe4-99dd-2e31fee1e1b8" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2019-04-06T01:53:58.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "{score}" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "{score}" ] ; | |
| fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" | |
| ] | |
| ] . | |
| <urn:uuid:c4f2237b-a6d3-2837-164f-36de6089a27a> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8867-4" ] ; | |
| fhir:Coding.display [ fhir:value "Heart rate" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Heart rate" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2021-04-09T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "/min" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "/min" ] ; | |
| fhir:Quantity.value [ fhir:value "92"^^xsd:decimal ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" | |
| ] | |
| ] . | |
| <urn:uuid:b6e60da1-85d4-01ae-6031-534d70158497> | |
| rdf:type fhir:Procedure ; | |
| fhir:Procedure.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "866148006" ] ; | |
| fhir:Coding.display [ fhir:value "Screening for domestic abuse (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Screening for domestic abuse (procedure)" ] | |
| ] ; | |
| fhir:Procedure.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] | |
| ] ; | |
| fhir:Procedure.location [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:Procedure.performedPeriod [ fhir:Period.end [ fhir:value "2017-04-01T01:08:36-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2017-04-01T00:39:39-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Procedure.status [ fhir:value | |
| "completed" ] ; | |
| fhir:Procedure.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" | |
| ] | |
| ] . | |
| <urn:uuid:373ffcbf-c22c-ab87-5ceb-06bb75089e80> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8302-2" ] ; | |
| fhir:Coding.display [ fhir:value "Body Height" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Body Height" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2019-04-05T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f466d2cb-3b48-2fe4-99dd-2e31fee1e1b8" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2019-04-05T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "cm" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "cm" ] ; | |
| fhir:Quantity.value [ fhir:value 169.1 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" | |
| ] | |
| ] . | |
| <urn:uuid:188de3d3-484a-cc06-06fc-a1f2f6fddcf4> | |
| rdf:type fhir:Immunization ; | |
| fhir:Immunization.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] | |
| ] ; | |
| fhir:Immunization.location [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:Immunization.occurrenceDateTime | |
| [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Immunization.patient [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Immunization.primarySource | |
| [ fhir:value true ] ; | |
| fhir:Immunization.status [ fhir:value | |
| "completed" ] ; | |
| fhir:Immunization.vaccineCode [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "140" ] ; | |
| fhir:Coding.display [ fhir:value "Influenza, seasonal, injectable, preservative free" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/cvx"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Influenza, seasonal, injectable, preservative free" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" | |
| ] | |
| ] . | |
| <urn:uuid:17562be7-8341-e60f-8196-6b952bbc23e6> | |
| rdf:type fhir:Encounter ; | |
| fhir:Encounter.class [ fhir:Coding.code [ fhir:value "AMB" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] | |
| ] ; | |
| fhir:Encounter.identifier [ fhir:Identifier.system [ fhir:value "https://github.com/synthetichealth/synthea"^^xsd:anyURI ] ; | |
| fhir:Identifier.use [ fhir:value "official" ] ; | |
| fhir:Identifier.value [ fhir:value "17562be7-8341-e60f-8196-6b952bbc23e6" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Encounter.location [ fhir:Encounter.location.location | |
| [ fhir:Reference.display [ fhir:value "BRIGHAM AND WOMEN'S FAULKNER HOSPITAL, INC." ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|879680f0-7d30-38dc-8476-145aa229a0c4" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Encounter.participant [ fhir:Encounter.participant.individual | |
| [ fhir:Reference.display [ fhir:value "Dr. Eldora89 Langosh790" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] | |
| ] ; | |
| fhir:Encounter.participant.period | |
| [ fhir:Period.end [ fhir:value "2022-11-01T13:00:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2022-11-01T12:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Encounter.participant.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "PPRF" ] ; | |
| fhir:Coding.display [ fhir:value "primary performer" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ParticipationType"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "primary performer" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Encounter.period [ fhir:Period.end [ fhir:value "2022-11-01T13:00:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2022-11-01T12:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Encounter.reasonCode [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "195662009" ] ; | |
| fhir:Coding.display [ fhir:value "Acute viral pharyngitis (disorder)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Encounter.serviceProvider [ fhir:Reference.display [ fhir:value "BRIGHAM AND WOMEN'S FAULKNER HOSPITAL, INC." ] ; | |
| fhir:Reference.reference [ fhir:value "Organization?identifier=https://github.com/synthetichealth/synthea|f312977e-8f41-3816-84cc-e5b12ba36955" ] | |
| ] ; | |
| fhir:Encounter.status [ fhir:value | |
| "finished" ] ; | |
| fhir:Encounter.subject [ fhir:Reference.display [ fhir:value "Mr. Darrick836 Bennett146 Wunsch504" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Encounter.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "185345009" ] ; | |
| fhir:Coding.display [ fhir:value "Encounter for symptom" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Encounter for symptom" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" | |
| ] | |
| ] . | |
| <urn:uuid:270b5631-8493-5df4-0227-3170e8ce4409> | |
| rdf:type fhir:DiagnosticReport ; | |
| fhir:DiagnosticReport.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:DiagnosticReport.effectiveDateTime | |
| [ fhir:value "2022-11-09T23:09:56-05:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:0d7f9a4e-58f4-4ac4-9824-2d8ff5c98e5a" ] | |
| ] ; | |
| fhir:DiagnosticReport.issued [ fhir:value | |
| "2022-11-09T23:09:56.960-05:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.performer | |
| [ fhir:Reference.display [ fhir:value "Dr. Emma804 Larkin917" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883090" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.presentedForm | |
| [ fhir:Attachment.contentType [ fhir:value | |
| "text/plain; charset=utf-8" ] ; | |
| fhir:Attachment.data [ fhir:value | |
| "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" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.status [ fhir:value | |
| "final" ] ; | |
| fhir:DiagnosticReport.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" | |
| ] | |
| ] . | |
| <urn:uuid:6572405d-8df1-082d-3794-d66cd2985812> | |
| rdf:type fhir:Claim ; | |
| fhir:Claim.billablePeriod [ fhir:Period.end [ fhir:value "2024-06-18T14:00:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2024-06-18T13:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Claim.created [ fhir:value "2024-06-18T14:00:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Claim.insurance [ fhir:Claim.insurance.coverage [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Claim.insurance.focal [ fhir:value | |
| true ] ; | |
| fhir:Claim.insurance.sequence [ fhir:value | |
| "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:8b1ddb2f-d0a3-73b0-f0f0-b53d08409bcd" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "313782" ] ; | |
| fhir:Coding.display [ fhir:value "Acetaminophen 325 MG Oral Tablet" ] ; | |
| fhir:Coding.system [ fhir:value "http://www.nlm.nih.gov/research/umls/rxnorm"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Acetaminophen 325 MG Oral Tablet" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.patient [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Claim.prescription [ fhir:Reference.reference [ fhir:value "urn:uuid:406c18c1-7722-7c1a-4677-6f880e92ac3a" ] | |
| ] ; | |
| fhir:Claim.priority [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "normal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.provider [ fhir:Reference.display [ fhir:value "BRIGHAM AND WOMEN'S FAULKNER HOSPITAL, INC." ] ; | |
| fhir:Reference.reference [ fhir:value "Organization?identifier=https://github.com/synthetichealth/synthea|f312977e-8f41-3816-84cc-e5b12ba36955" ] | |
| ] ; | |
| fhir:Claim.status [ fhir:value "active" ] ; | |
| fhir:Claim.total [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 99.39 ] | |
| ] ; | |
| fhir:Claim.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "pharmacy" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.use [ fhir:value "claim" ] . | |
| <urn:uuid:5dd8ae9f-e650-8d11-c403-1c2dd6782ae1> | |
| rdf:type fhir:ExplanationOfBenefit ; | |
| fhir:DomainResource.contained [ rdf:type fhir:ServiceRequest ; | |
| fhir:Resource.id [ fhir:value | |
| "referral" ] ; | |
| fhir:ServiceRequest.intent [ fhir:value | |
| "order" ] ; | |
| fhir:ServiceRequest.performer [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ServiceRequest.requester [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] | |
| ] ; | |
| fhir:ServiceRequest.status [ fhir:value | |
| "completed" ] ; | |
| fhir:ServiceRequest.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DomainResource.contained [ rdf:type fhir:Coverage ; | |
| fhir:Coverage.beneficiary [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Coverage.payor [ fhir:Reference.display [ fhir:value "UnitedHealthcare" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Coverage.status [ fhir:value "active" ] ; | |
| fhir:Coverage.type [ fhir:CodeableConcept.text [ fhir:value "UnitedHealthcare" ] | |
| ] ; | |
| fhir:Resource.id [ fhir:value "coverage" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.billablePeriod | |
| [ fhir:Period.end [ fhir:value "2015-02-02T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2014-02-02T23:00:06-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam | |
| [ fhir:ExplanationOfBenefit.careTeam.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.role | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "primary" ] ; | |
| fhir:Coding.display [ fhir:value "Primary provider" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claimcareteamrole"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.claim | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:03e64cc2-5ea9-5333-4901-fa523b433583" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.created | |
| [ fhir:value "2014-02-02T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:246c8af4-d044-fd6b-ac14-0a6e0db35888" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "3" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:62d20363-e046-1ba0-b646-62c56df447f5" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:91357659-5db2-98e7-ec08-ce202a8f2def" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.facility | |
| [ fhir:Reference.display [ fhir:value "BRIGHAM AND WOMEN'S FAULKNER HOSPITAL, INC." ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|879680f0-7d30-38dc-8476-145aa229a0c4" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/clm_id"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "03e64cc2-5ea9-5333-4901-fa523b433583" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/identifier/claim-group"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "99999999999" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance | |
| [ fhir:ExplanationOfBenefit.insurance.coverage | |
| [ fhir:Reference.display [ fhir:value "UnitedHealthcare" ] ; | |
| fhir:Reference.reference [ fhir:value "#coverage" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance.focal | |
| [ fhir:value true ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurer | |
| [ fhir:Reference.display [ fhir:value "UnitedHealthcare" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "21" ] ; | |
| fhir:Coding.display [ fhir:value "Inpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "82423001" ] ; | |
| fhir:Coding.display [ fhir:value "Chronic pain (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Chronic pain (finding)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2014-02-02T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2014-02-02T22:45:06-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "3" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "21" ] ; | |
| fhir:Coding.display [ fhir:value "Inpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1121000119107" ] ; | |
| fhir:Coding.display [ fhir:value "Chronic neck pain (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Chronic neck pain (finding)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "4" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2014-02-02T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2014-02-02T22:45:06-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:236af474-49fb-8892-d08f-accafdd535c8" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "21" ] ; | |
| fhir:Coding.display [ fhir:value "Inpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "185347001" ] ; | |
| fhir:Coding.display [ fhir:value "Encounter for problem (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Encounter for problem (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2014-02-02T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2014-02-02T22:45:06-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "21" ] ; | |
| fhir:Coding.display [ fhir:value "Inpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "278860009" ] ; | |
| fhir:Coding.display [ fhir:value "Chronic low back pain (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Chronic low back pain (finding)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "3" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2014-02-02T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2014-02-02T22:45:06-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.outcome | |
| [ fhir:value "complete" ] ; | |
| fhir:ExplanationOfBenefit.patient | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.payment | |
| [ fhir:ExplanationOfBenefit.payment.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 0.0 ] | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.referral | |
| [ fhir:Reference.reference [ fhir:value "#referral" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.status | |
| [ fhir:value "active" ] ; | |
| fhir:ExplanationOfBenefit.total | |
| [ fhir:ExplanationOfBenefit.total.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 85.55 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.total.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "submitted" ] ; | |
| fhir:Coding.display [ fhir:value "Submitted Amount" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Submitted Amount" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "professional" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.use [ fhir:value | |
| "claim" ] . | |
| <urn:uuid:e6108b85-7316-ee0b-9d36-eeb680faa21c> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "laboratory" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "787-2" ] ; | |
| fhir:Coding.display [ fhir:value "MCV [Entitic volume] by Automated count" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "MCV [Entitic volume] by Automated count" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2015-03-27T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:e0623eab-bc78-461e-cb51-4cdf6916360e" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2015-03-27T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "fL" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "fL" ] ; | |
| fhir:Quantity.value [ fhir:value 81.372 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" | |
| ] | |
| ] . | |
| <urn:uuid:28d03d3b-3959-d581-d766-60e07b5bd838> | |
| rdf:type fhir:ImagingStudy ; | |
| fhir:ImagingStudy.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:0d7f9a4e-58f4-4ac4-9824-2d8ff5c98e5a" ] | |
| ] ; | |
| fhir:ImagingStudy.identifier [ fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986"^^xsd:anyURI ] ; | |
| fhir:Identifier.use [ fhir:value "official" ] ; | |
| fhir:Identifier.value [ fhir:value "urn:oid:1.2.840.99999999.52944855.1668053396960" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ImagingStudy.location [ fhir:Reference.display [ fhir:value "RECUPERATIVE SERVICES UNIT-HEBREW REHAB CENTER" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|cb8fd45a-2e3a-34f7-9552-dddb7c246cef" ] | |
| ] ; | |
| fhir:ImagingStudy.numberOfInstances | |
| [ fhir:value "1" ] ; | |
| fhir:ImagingStudy.numberOfSeries | |
| [ fhir:value "1" ] ; | |
| fhir:ImagingStudy.procedureCode | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "168594001" ] ; | |
| fhir:Coding.display [ fhir:value "Clavicle X-ray" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Clavicle X-ray" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ImagingStudy.series [ fhir:ImagingStudy.series.bodySite | |
| [ fhir:Coding.code [ fhir:value "51299004" ] ; | |
| fhir:Coding.display [ fhir:value "Clavicle" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] | |
| ] ; | |
| fhir:ImagingStudy.series.instance | |
| [ fhir:ImagingStudy.series.instance.number | |
| [ fhir:value "1" ] ; | |
| fhir:ImagingStudy.series.instance.sopClass | |
| [ fhir:Coding.code [ fhir:value "urn:oid:1.2.840.10008.5.1.4.1.1.1.1" ] ; | |
| fhir:Coding.system [ fhir:value "urn:ietf:rfc:3986"^^xsd:anyURI ] | |
| ] ; | |
| fhir:ImagingStudy.series.instance.title | |
| [ fhir:value "Image of clavicle" ] ; | |
| fhir:ImagingStudy.series.instance.uid | |
| [ fhir:value "1.2.840.99999999.1.1.11190102.1668053396960" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ImagingStudy.series.modality | |
| [ fhir:Coding.code [ fhir:value "DX" ] ; | |
| fhir:Coding.display [ fhir:value "Digital Radiography" ] ; | |
| fhir:Coding.system [ fhir:value "http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html"^^xsd:anyURI ] | |
| ] ; | |
| fhir:ImagingStudy.series.number | |
| [ fhir:value "1" ] ; | |
| fhir:ImagingStudy.series.numberOfInstances | |
| [ fhir:value "1" ] ; | |
| fhir:ImagingStudy.series.started | |
| [ fhir:value "2022-11-09T23:09:56-05:00"^^xsd:dateTime ] ; | |
| fhir:ImagingStudy.series.uid [ fhir:value | |
| "1.2.840.99999999.1.74650569.1668053396960" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ImagingStudy.started [ fhir:value | |
| "2022-11-09T23:09:56-05:00"^^xsd:dateTime ] ; | |
| fhir:ImagingStudy.status [ fhir:value | |
| "available" ] ; | |
| fhir:ImagingStudy.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] . | |
| <urn:uuid:3d72b77d-140d-3b90-5280-e9e6ed5aed4e> | |
| rdf:type fhir:ExplanationOfBenefit ; | |
| fhir:DomainResource.contained [ rdf:type fhir:ServiceRequest ; | |
| fhir:Resource.id [ fhir:value | |
| "referral" ] ; | |
| fhir:ServiceRequest.intent [ fhir:value | |
| "order" ] ; | |
| fhir:ServiceRequest.performer [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883090" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ServiceRequest.requester [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883090" ] | |
| ] ; | |
| fhir:ServiceRequest.status [ fhir:value | |
| "completed" ] ; | |
| fhir:ServiceRequest.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DomainResource.contained [ rdf:type fhir:Coverage ; | |
| fhir:Coverage.beneficiary [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Coverage.payor [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Coverage.status [ fhir:value "active" ] ; | |
| fhir:Coverage.type [ fhir:CodeableConcept.text [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Resource.id [ fhir:value "coverage" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.billablePeriod | |
| [ fhir:Period.end [ fhir:value "2023-11-10T00:41:56-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2022-11-10T00:41:56-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam | |
| [ fhir:ExplanationOfBenefit.careTeam.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883090" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.role | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "primary" ] ; | |
| fhir:Coding.display [ fhir:value "Primary provider" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claimcareteamrole"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.claim | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:c53010e8-0c4e-2894-e74d-276f57a5fa19" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.created | |
| [ fhir:value "2022-11-10T00:41:56-05:00"^^xsd:dateTime ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:0543cb87-f19d-95ed-d182-d3c12f52a584" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:59e99f19-2a84-b008-61b3-cb369b2d1077" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.facility | |
| [ fhir:Reference.display [ fhir:value "RECUPERATIVE SERVICES UNIT-HEBREW REHAB CENTER" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|cb8fd45a-2e3a-34f7-9552-dddb7c246cef" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/identifier/claim-group"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "99999999999" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/clm_id"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "c53010e8-0c4e-2894-e74d-276f57a5fa19" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance | |
| [ fhir:ExplanationOfBenefit.insurance.coverage | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:Reference.reference [ fhir:value "#coverage" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance.focal | |
| [ fhir:value true ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurer | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "20" ] ; | |
| fhir:Coding.display [ fhir:value "Urgent Care Facility" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "125605004" ] ; | |
| fhir:Coding.display [ fhir:value "Fracture of bone (disorder)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Fracture of bone (disorder)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2022-11-10T00:41:56-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2022-11-09T23:09:56-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "20" ] ; | |
| fhir:Coding.display [ fhir:value "Urgent Care Facility" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "58150001" ] ; | |
| fhir:Coding.display [ fhir:value "Fracture of clavicle" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Fracture of clavicle" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "3" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2022-11-10T00:41:56-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2022-11-09T23:09:56-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 10934.496000000001 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 13668.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 2733.6240000000003 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 13668.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "20" ] ; | |
| fhir:Coding.display [ fhir:value "Urgent Care Facility" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 13668.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "312681000" ] ; | |
| fhir:Coding.display [ fhir:value "Bone density scan (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Bone density scan (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "6" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2022-11-10T00:41:56-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2022-11-09T23:09:56-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "20" ] ; | |
| fhir:Coding.display [ fhir:value "Urgent Care Facility" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "305428000" ] ; | |
| fhir:Coding.display [ fhir:value "Admission to orthopedic department" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Admission to orthopedic department" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "5" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2022-11-10T00:41:56-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2022-11-09T23:09:56-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:0d7f9a4e-58f4-4ac4-9824-2d8ff5c98e5a" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "20" ] ; | |
| fhir:Coding.display [ fhir:value "Urgent Care Facility" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "50849002" ] ; | |
| fhir:Coding.display [ fhir:value "Emergency room admission (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Emergency room admission (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2022-11-10T00:41:56-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2022-11-09T23:09:56-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "20" ] ; | |
| fhir:Coding.display [ fhir:value "Urgent Care Facility" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "168594001" ] ; | |
| fhir:Coding.display [ fhir:value "Clavicle X-ray" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Clavicle X-ray" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "4" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2022-11-10T00:41:56-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2022-11-09T23:09:56-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.outcome | |
| [ fhir:value "complete" ] ; | |
| fhir:ExplanationOfBenefit.patient | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.payment | |
| [ fhir:ExplanationOfBenefit.payment.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 11624.736 ] | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883090" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.referral | |
| [ fhir:Reference.reference [ fhir:value "#referral" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.status | |
| [ fhir:value "active" ] ; | |
| fhir:ExplanationOfBenefit.total | |
| [ fhir:ExplanationOfBenefit.total.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 14677.10 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.total.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "submitted" ] ; | |
| fhir:Coding.display [ fhir:value "Submitted Amount" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Submitted Amount" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "institutional" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.use [ fhir:value | |
| "claim" ] . | |
| <urn:uuid:6eb5221b-f084-a838-dac9-1bc9a2019920> | |
| rdf:type fhir:Claim ; | |
| fhir:Claim.billablePeriod [ fhir:Period.end [ fhir:value "2024-06-18T14:00:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2024-06-18T13:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Claim.created [ fhir:value "2024-06-18T14:00:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Claim.diagnosis [ fhir:Claim.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:1b0a0850-5a6f-7732-8bc7-1488986f79d8" ] | |
| ] ; | |
| fhir:Claim.diagnosis.sequence [ fhir:value | |
| "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.facility [ fhir:Reference.display [ fhir:value "BRIGHAM AND WOMEN'S FAULKNER HOSPITAL, INC." ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|879680f0-7d30-38dc-8476-145aa229a0c4" ] | |
| ] ; | |
| fhir:Claim.insurance [ fhir:Claim.insurance.coverage [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Claim.insurance.focal [ fhir:value | |
| true ] ; | |
| fhir:Claim.insurance.sequence [ fhir:value | |
| "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:8b1ddb2f-d0a3-73b0-f0f0-b53d08409bcd" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "185345009" ] ; | |
| fhir:Coding.display [ fhir:value "Encounter for symptom" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Encounter for symptom" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "10509002" ] ; | |
| fhir:Coding.display [ fhir:value "Acute bronchitis (disorder)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Acute bronchitis (disorder)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "2" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:Claim.item [ fhir:Claim.item.net [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 541.00 ] | |
| ] ; | |
| fhir:Claim.item.procedureSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:Claim.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "23426006" ] ; | |
| fhir:Coding.display [ fhir:value "Measurement of respiratory function (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Measurement of respiratory function (procedure)" ] | |
| ] ; | |
| fhir:Claim.item.sequence [ fhir:value "3" ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:Claim.patient [ fhir:Reference.display [ fhir:value "Darrick836 Wunsch504" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Claim.priority [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "normal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.procedure [ fhir:Claim.procedure.procedureReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:570f5fae-c6bd-f7f0-ad85-1c8b93cd6717" ] | |
| ] ; | |
| fhir:Claim.procedure.sequence [ fhir:value | |
| "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Claim.provider [ fhir:Reference.display [ fhir:value "BRIGHAM AND WOMEN'S FAULKNER HOSPITAL, INC." ] ; | |
| fhir:Reference.reference [ fhir:value "Organization?identifier=https://github.com/synthetichealth/synthea|f312977e-8f41-3816-84cc-e5b12ba36955" ] | |
| ] ; | |
| fhir:Claim.status [ fhir:value "active" ] ; | |
| fhir:Claim.total [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 626.55 ] | |
| ] ; | |
| fhir:Claim.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "professional" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Claim.use [ fhir:value "claim" ] . | |
| <urn:uuid:6ba502de-5270-cde4-4ba3-1b6abeba4efb> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "laboratory" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "18262-6" ] ; | |
| fhir:Coding.display [ fhir:value "Low Density Lipoprotein Cholesterol" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Low Density Lipoprotein Cholesterol" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2024-06-28T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:dc45fcbf-ba0f-6398-3e31-3c9af0fb3288" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2024-06-28T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "mg/dL" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "mg/dL" ] ; | |
| fhir:Quantity.value [ fhir:value 73.6 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" | |
| ] | |
| ] . | |
| <urn:uuid:fbaebc0d-07d0-2104-08c2-85f36a2b41ee> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8867-4" ] ; | |
| fhir:Coding.display [ fhir:value "Heart rate" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Heart rate" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2017-03-31T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "/min" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "/min" ] ; | |
| fhir:Quantity.value [ fhir:value "84"^^xsd:decimal ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" | |
| ] | |
| ] . | |
| <urn:uuid:e485fa64-9215-213a-ea10-ed0031a7c662> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "72514-3" ] ; | |
| fhir:Coding.display [ fhir:value "Pain severity - 0-10 verbal numeric rating [Score] - Reported" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Pain severity - 0-10 verbal numeric rating [Score] - Reported" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2015-03-27T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:e0623eab-bc78-461e-cb51-4cdf6916360e" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2015-03-27T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "{score}" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "{score}" ] ; | |
| fhir:Quantity.value [ fhir:value "2"^^xsd:decimal ] | |
| ] . | |
| <urn:uuid:18168b97-e5e6-7dfc-cb2a-c3168cef26b4> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "laboratory" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "2093-3" ] ; | |
| fhir:Coding.display [ fhir:value "Cholesterol [Mass/volume] in Serum or Plasma" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Cholesterol [Mass/volume] in Serum or Plasma" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2021-04-09T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "mg/dL" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "mg/dL" ] ; | |
| fhir:Quantity.value [ fhir:value 238.61 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" | |
| ] | |
| ] . | |
| <urn:uuid:7f201e9f-590a-d281-75ef-f7ae128f0948> | |
| rdf:type fhir:DocumentReference ; | |
| fhir:DocumentReference.author [ fhir:Reference.display [ fhir:value "Dr. Alejandra902 Thompson596" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "clinical-note" ] ; | |
| fhir:Coding.display [ fhir:value "Clinical Note" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.content [ fhir:DocumentReference.content.attachment | |
| [ fhir:Attachment.contentType [ fhir:value | |
| "text/plain; charset=utf-8" ] ; | |
| fhir:Attachment.data [ fhir:value | |
| "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" ] | |
| ] ; | |
| fhir:DocumentReference.content.format | |
| [ fhir:Coding.code [ fhir:value "urn:ihe:iti:xds:2017:mimeTypeSufficient" ] ; | |
| fhir:Coding.display [ fhir:value "mimeType Sufficient" ] ; | |
| fhir:Coding.system [ fhir:value "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode"^^xsd:anyURI ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.context [ fhir:DocumentReference.context.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:f466d2cb-3b48-2fe4-99dd-2e31fee1e1b8" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.context.period | |
| [ fhir:Period.end [ fhir:value "2019-04-06T00:34:44-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2019-04-05T23:45:06-04:00"^^xsd:dateTime ] | |
| ] | |
| ] ; | |
| fhir:DocumentReference.custodian | |
| [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Organization?identifier=https://github.com/synthetichealth/synthea|ace1ac31-036a-38fd-b451-b3b87157c717" ] | |
| ] ; | |
| fhir:DocumentReference.date [ fhir:value | |
| "2019-04-05T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DocumentReference.identifier | |
| [ fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "urn:uuid:777f540d-accb-8d08-9956-84b485aa6703" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.status [ fhir:value | |
| "superseded" ] ; | |
| fhir:DocumentReference.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:DocumentReference.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" | |
| ] | |
| ] . | |
| <urn:uuid:1c1bc394-6959-c059-8408-4af12bf523d4> | |
| rdf:type fhir:DiagnosticReport ; | |
| fhir:DiagnosticReport.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:DiagnosticReport.effectiveDateTime | |
| [ fhir:value "2014-02-02T22:45:06-05:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:236af474-49fb-8892-d08f-accafdd535c8" ] | |
| ] ; | |
| fhir:DiagnosticReport.issued [ fhir:value | |
| "2014-02-02T22:45:06.960-05:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.performer | |
| [ fhir:Reference.display [ fhir:value "Dr. Eldora89 Langosh790" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.presentedForm | |
| [ fhir:Attachment.contentType [ fhir:value | |
| "text/plain; charset=utf-8" ] ; | |
| fhir:Attachment.data [ fhir:value | |
| "CjIwMTQtMDItMDIKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gRmF0aWd1ZQotIFNob3J0bmVzcyBvZiBCcmVhdGgKLSBNdWN1cwotIEZldmVyCi0gU29yZSBUaHJvYXQKLSBOYXNhbCBDb25nZXN0aW9uCgoKIyBIaXN0b3J5IG9mIFByZXNlbnQgSWxsbmVzcwpEYXJyaWNrODM2CiBpcyBhIDM4IHllYXItb2xkIG5vbmhpc3BhbmljIGJsYWNrIG1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBmdWxsLXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIHN0cmVzcyAoZmluZGluZykuCgojIFNvY2lhbCBIaXN0b3J5ClBhdGllbnQgaXMgbWFycmllZC4gUGF0aWVudCBxdWl0IHNtb2tpbmcgYXQgYWdlIDE2LgogUGF0aWVudCBpZGVudGlmaWVzIGFzIGhldGVyb3NleHVhbC4KClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCiBQYXRpZW50IGhhcyBjb21wbGV0ZWQgc29tZSBjb2xsZWdlIGNvdXJzZXMuClBhdGllbnQgY3VycmVudGx5IGhhcyBVbml0ZWRIZWFsdGhjYXJlLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwpObyBBY3RpdmUgTWVkaWNhdGlvbnMuCgojIEFzc2Vzc21lbnQgYW5kIFBsYW4KUGF0aWVudCBpcyBwcmVzZW50aW5nIHdpdGggY2hyb25pYyBwYWluIChmaW5kaW5nKSwgY2hyb25pYyBsb3cgYmFjayBwYWluIChmaW5kaW5nKSwgY2hyb25pYyBuZWNrIHBhaW4gKGZpbmRpbmcpLiAKCiMjIFBsYW4KCg==" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.status [ fhir:value | |
| "final" ] ; | |
| fhir:DiagnosticReport.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" | |
| ] | |
| ] . | |
| <urn:uuid:f20d5c56-f6da-872b-8437-cbc3555df494> | |
| rdf:type fhir:DiagnosticReport ; | |
| fhir:DiagnosticReport.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "69737-5" ] ; | |
| fhir:Coding.display [ fhir:value "Generalized anxiety disorder 7 item (GAD-7)" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Generalized anxiety disorder 7 item (GAD-7)" ] | |
| ] ; | |
| fhir:DiagnosticReport.effectiveDateTime | |
| [ fhir:value "2015-03-28T00:58:17-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:e0623eab-bc78-461e-cb51-4cdf6916360e" ] | |
| ] ; | |
| fhir:DiagnosticReport.issued [ fhir:value | |
| "2015-03-28T00:58:17.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.result [ fhir:Reference.display [ fhir:value "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:e718b729-9e9d-2f0b-2831-f516148270f7" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.status [ fhir:value | |
| "final" ] ; | |
| fhir:DiagnosticReport.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] . | |
| <urn:uuid:d58bcafe-acab-2e34-e113-051bacd6e3f6> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "72514-3" ] ; | |
| fhir:Coding.display [ fhir:value "Pain severity - 0-10 verbal numeric rating [Score] - Reported" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Pain severity - 0-10 verbal numeric rating [Score] - Reported" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2021-04-09T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "{score}" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "{score}" ] ; | |
| fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ] | |
| ] . | |
| <urn:uuid:cd2815b1-28c3-0543-5e4d-f75f53309334> | |
| rdf:type fhir:ExplanationOfBenefit ; | |
| fhir:DomainResource.contained [ rdf:type fhir:Coverage ; | |
| fhir:Coverage.beneficiary [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Coverage.payor [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Coverage.status [ fhir:value "active" ] ; | |
| fhir:Coverage.type [ fhir:CodeableConcept.text [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Resource.id [ fhir:value "coverage" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:DomainResource.contained [ rdf:type fhir:ServiceRequest ; | |
| fhir:Resource.id [ fhir:value | |
| "referral" ] ; | |
| fhir:ServiceRequest.intent [ fhir:value | |
| "order" ] ; | |
| fhir:ServiceRequest.performer [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ServiceRequest.requester [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ServiceRequest.status [ fhir:value | |
| "completed" ] ; | |
| fhir:ServiceRequest.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.billablePeriod | |
| [ fhir:Period.end [ fhir:value "2022-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam | |
| [ fhir:ExplanationOfBenefit.careTeam.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.role | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "primary" ] ; | |
| fhir:Coding.display [ fhir:value "Primary provider" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claimcareteamrole"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.claim | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:c3ba316e-ce5b-b65f-2b36-42c251580772" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.created | |
| [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:1eacf9ed-0ce2-825a-5165-3baa2c095336" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis | |
| [ fhir:ExplanationOfBenefit.diagnosis.diagnosisReference | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:6ec5c1eb-cd32-603d-fde1-3e7292108365" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.diagnosis.type | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "principal" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.facility | |
| [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/clm_id"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "c3ba316e-ce5b-b65f-2b36-42c251580772" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/identifier/claim-group"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "99999999999" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance | |
| [ fhir:ExplanationOfBenefit.insurance.coverage | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:Reference.reference [ fhir:value "#coverage" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance.focal | |
| [ fhir:value true ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurer | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "710824005" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of health and social care needs (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of health and social care needs (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "6" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 403.944 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 100.986 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 504.93 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 504.93 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 504.93 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "430193006" ] ; | |
| fhir:Coding.display [ fhir:value "Medication Reconciliation (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Medication Reconciliation (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "3" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 59.664 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 14.916 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "5" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "76499-3" ] ; | |
| fhir:Coding.display [ fhir:value "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "12" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 11 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 59.664 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 14.916 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "4" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "69737-5" ] ; | |
| fhir:Coding.display [ fhir:value "Generalized anxiety disorder 7 item (GAD-7)" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Generalized anxiety disorder 7 item (GAD-7)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "10" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 9 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 27.200000000000003 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 108.80000000000001 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "140" ] ; | |
| fhir:Coding.display [ fhir:value "Influenza, seasonal, injectable, preservative free" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/cvx"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Influenza, seasonal, injectable, preservative free" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "171207006" ] ; | |
| fhir:Coding.display [ fhir:value "Depression screening (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Depression screening (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "13" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 12 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "710841007" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of anxiety (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of anxiety (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "9" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 8 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "160904001" ] ; | |
| fhir:Coding.display [ fhir:value "Part-time employment (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Part-time employment (finding)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "7" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 6 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "454711000124102" ] ; | |
| fhir:Coding.display [ fhir:value "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:Coding.version [ fhir:value "http://snomed.info/sct/731000124108" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "14" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 13 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 14.916 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 59.664 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "6" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "55757-9" ] ; | |
| fhir:Coding.display [ fhir:value "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "15" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 14 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 59.664 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 14.916 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "57698-3" ] ; | |
| fhir:Coding.display [ fhir:value "Lipid panel with direct LDL - Serum or Plasma" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Lipid panel with direct LDL - Serum or Plasma" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "4" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 14.916 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 59.664 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "3" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 74.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "58410-2" ] ; | |
| fhir:Coding.display [ fhir:value "CBC panel - Blood by Automated count" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "CBC panel - Blood by Automated count" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "5" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.diagnosisSequence | |
| [ fhir:index 0 ; | |
| fhir:value "2" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "73595000" ] ; | |
| fhir:Coding.display [ fhir:value "Stress (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Stress (finding)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "8" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 7 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 86.28 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 345.12 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 431.40 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "866148006" ] ; | |
| fhir:Coding.display [ fhir:value "Screening for domestic abuse (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Screening for domestic abuse (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "11" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 10 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "19" ] ; | |
| fhir:Coding.display [ fhir:value "Off Campus-Outpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "162673000" ] ; | |
| fhir:Coding.display [ fhir:value "General examination of patient (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "General examination of patient (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.outcome | |
| [ fhir:value "complete" ] ; | |
| fhir:ExplanationOfBenefit.patient | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.payment | |
| [ fhir:ExplanationOfBenefit.payment.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 2536.664 ] | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.referral | |
| [ fhir:Reference.reference [ fhir:value "#referral" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.status | |
| [ fhir:value "active" ] ; | |
| fhir:ExplanationOfBenefit.total | |
| [ fhir:ExplanationOfBenefit.total.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 1358.29 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.total.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "submitted" ] ; | |
| fhir:Coding.display [ fhir:value "Submitted Amount" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Submitted Amount" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "professional" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.use [ fhir:value | |
| "claim" ] . | |
| <urn:uuid:b33c75d9-a7c1-e201-0141-476d60cca7d0> | |
| rdf:type fhir:Procedure ; | |
| fhir:Procedure.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "710824005" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of health and social care needs (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of health and social care needs (procedure)" ] | |
| ] ; | |
| fhir:Procedure.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Procedure.location [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:Procedure.performedPeriod [ fhir:Period.end [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Procedure.status [ fhir:value | |
| "completed" ] ; | |
| fhir:Procedure.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" | |
| ] | |
| ] . | |
| <urn:uuid:0db69d3c-9b68-6180-25db-389350128bbd> | |
| rdf:type fhir:Procedure ; | |
| fhir:Procedure.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "710824005" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of health and social care needs (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of health and social care needs (procedure)" ] | |
| ] ; | |
| fhir:Procedure.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:9c748b35-c9f0-6c85-47af-4434fa1ba3d1" ] | |
| ] ; | |
| fhir:Procedure.location [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:Procedure.performedPeriod [ fhir:Period.end [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Procedure.status [ fhir:value | |
| "completed" ] ; | |
| fhir:Procedure.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" | |
| ] | |
| ] . | |
| <urn:uuid:b0a12816-e320-cf4b-a8f6-7ed4bdf27c68> | |
| rdf:type fhir:Condition ; | |
| fhir:Condition.abatementDateTime | |
| [ fhir:value "2015-09-08T00:09:56-04:00"^^xsd:dateTime ] ; | |
| fhir:Condition.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "encounter-diagnosis" ] ; | |
| fhir:Coding.display [ fhir:value "Encounter Diagnosis" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Condition.clinicalStatus [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "resolved" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-clinical"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Condition.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "312608009" ] ; | |
| fhir:Coding.display [ fhir:value "Laceration - injury (disorder)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Laceration - injury (disorder)" ] | |
| ] ; | |
| fhir:Condition.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:a2a0afbe-5c77-c45a-7fcd-e62cc76d2a9d" ] | |
| ] ; | |
| fhir:Condition.onsetDateTime [ fhir:value | |
| "2015-08-23T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Condition.recordedDate [ fhir:value | |
| "2015-08-23T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Condition.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Condition.verificationStatus | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "confirmed" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-ver-status"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" | |
| ] | |
| ] . | |
| <urn:uuid:beff7d9a-23e9-78a4-5742-ea0990e70990> | |
| rdf:type fhir:DocumentReference ; | |
| fhir:DocumentReference.author [ fhir:Reference.display [ fhir:value "Dr. Eldora89 Langosh790" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "clinical-note" ] ; | |
| fhir:Coding.display [ fhir:value "Clinical Note" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.content [ fhir:DocumentReference.content.attachment | |
| [ fhir:Attachment.contentType [ fhir:value | |
| "text/plain; charset=utf-8" ] ; | |
| fhir:Attachment.data [ fhir:value | |
| "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" ] | |
| ] ; | |
| fhir:DocumentReference.content.format | |
| [ fhir:Coding.code [ fhir:value "urn:ihe:iti:xds:2017:mimeTypeSufficient" ] ; | |
| fhir:Coding.display [ fhir:value "mimeType Sufficient" ] ; | |
| fhir:Coding.system [ fhir:value "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode"^^xsd:anyURI ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.context [ fhir:DocumentReference.context.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:17562be7-8341-e60f-8196-6b952bbc23e6" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.context.period | |
| [ fhir:Period.end [ fhir:value "2022-11-01T13:00:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2022-11-01T12:45:06-04:00"^^xsd:dateTime ] | |
| ] | |
| ] ; | |
| fhir:DocumentReference.custodian | |
| [ fhir:Reference.display [ fhir:value "BRIGHAM AND WOMEN'S FAULKNER HOSPITAL, INC." ] ; | |
| fhir:Reference.reference [ fhir:value "Organization?identifier=https://github.com/synthetichealth/synthea|f312977e-8f41-3816-84cc-e5b12ba36955" ] | |
| ] ; | |
| fhir:DocumentReference.date [ fhir:value | |
| "2022-11-01T12:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DocumentReference.identifier | |
| [ fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "urn:uuid:3d6db379-4ddb-06b4-cb5b-532b6b4e1121" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.status [ fhir:value | |
| "superseded" ] ; | |
| fhir:DocumentReference.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:DocumentReference.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" | |
| ] | |
| ] . | |
| <urn:uuid:6c1bb638-9cc4-8440-091c-1c630a5274cf> | |
| rdf:type fhir:ExplanationOfBenefit ; | |
| fhir:DomainResource.contained [ rdf:type fhir:Coverage ; | |
| fhir:Coverage.beneficiary [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Coverage.payor [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Coverage.status [ fhir:value "active" ] ; | |
| fhir:Coverage.type [ fhir:CodeableConcept.text [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Resource.id [ fhir:value "coverage" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:DomainResource.contained [ rdf:type fhir:ServiceRequest ; | |
| fhir:Resource.id [ fhir:value | |
| "referral" ] ; | |
| fhir:ServiceRequest.intent [ fhir:value | |
| "order" ] ; | |
| fhir:ServiceRequest.performer [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ServiceRequest.requester [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] | |
| ] ; | |
| fhir:ServiceRequest.status [ fhir:value | |
| "completed" ] ; | |
| fhir:ServiceRequest.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.billablePeriod | |
| [ fhir:Period.end [ fhir:value "2022-02-05T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-02-05T23:00:06-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam | |
| [ fhir:ExplanationOfBenefit.careTeam.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.role | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "primary" ] ; | |
| fhir:Coding.display [ fhir:value "Primary provider" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claimcareteamrole"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.claim | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:bf63dcbc-fed6-650f-5259-7fd71ff4a272" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.created | |
| [ fhir:value "2021-02-05T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:ExplanationOfBenefit.facility | |
| [ fhir:Reference.display [ fhir:value "BRIGHAM AND WOMEN'S FAULKNER HOSPITAL, INC." ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|879680f0-7d30-38dc-8476-145aa229a0c4" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/identifier/claim-group"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "99999999999" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/clm_id"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "bf63dcbc-fed6-650f-5259-7fd71ff4a272" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance | |
| [ fhir:ExplanationOfBenefit.insurance.coverage | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:Reference.reference [ fhir:value "#coverage" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance.focal | |
| [ fhir:value true ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurer | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:097368e2-58d3-eba9-2992-6ef9dbb2c816" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "21" ] ; | |
| fhir:Coding.display [ fhir:value "Inpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "33879002" ] ; | |
| fhir:Coding.display [ fhir:value "Administration of vaccine to produce active immunity (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Administration of vaccine to produce active immunity (procedure)" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-02-05T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-02-05T22:45:06-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 108.80000000000001 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 27.200000000000003 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "21" ] ; | |
| fhir:Coding.display [ fhir:value "Inpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.net | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.productOrService | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "208" ] ; | |
| fhir:Coding.display [ fhir:value "COVID-19, mRNA, LNP-S, PF, 30 mcg/0.3 mL dose" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/cvx"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "COVID-19, mRNA, LNP-S, PF, 30 mcg/0.3 mL dose" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.sequence | |
| [ fhir:value "2" ] ; | |
| fhir:ExplanationOfBenefit.item.servicedPeriod | |
| [ fhir:Period.end [ fhir:value "2021-02-05T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-02-05T22:45:06-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.outcome | |
| [ fhir:value "complete" ] ; | |
| fhir:ExplanationOfBenefit.patient | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.payment | |
| [ fhir:ExplanationOfBenefit.payment.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 108.80000000000001 ] | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.referral | |
| [ fhir:Reference.reference [ fhir:value "#referral" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.status | |
| [ fhir:value "active" ] ; | |
| fhir:ExplanationOfBenefit.total | |
| [ fhir:ExplanationOfBenefit.total.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 278.58 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.total.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "submitted" ] ; | |
| fhir:Coding.display [ fhir:value "Submitted Amount" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Submitted Amount" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "professional" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.use [ fhir:value | |
| "claim" ] . | |
| <urn:uuid:4250b854-e364-1a7d-012a-faad88dbbf56> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "laboratory" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "18262-6" ] ; | |
| fhir:Coding.display [ fhir:value "Low Density Lipoprotein Cholesterol" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Low Density Lipoprotein Cholesterol" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2021-04-09T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "mg/dL" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "mg/dL" ] ; | |
| fhir:Quantity.value [ fhir:value 182.49 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" | |
| ] | |
| ] . | |
| <urn:uuid:d2b3e3de-f733-4a74-5097-a9fc58db5d76> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8302-2" ] ; | |
| fhir:Coding.display [ fhir:value "Body Height" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Body Height" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2024-06-28T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:dc45fcbf-ba0f-6398-3e31-3c9af0fb3288" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2024-06-28T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "cm" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "cm" ] ; | |
| fhir:Quantity.value [ fhir:value 169.1 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" | |
| ] | |
| ] . | |
| <urn:uuid:ff6186ba-e5b7-658c-d697-3079dae93fe6> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "laboratory" ] ; | |
| fhir:Coding.display [ fhir:value "Laboratory" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "32623-1" ] ; | |
| fhir:Coding.display [ fhir:value "Platelet mean volume [Entitic volume] in Blood by Automated count" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Platelet mean volume [Entitic volume] in Blood by Automated count" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2021-04-09T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "fL" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "fL" ] ; | |
| fhir:Quantity.value [ fhir:value 10.63 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" | |
| ] | |
| ] . | |
| <urn:uuid:bb7bee71-5318-1556-7997-90fc3bed3191> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "social-history" ] ; | |
| fhir:Coding.display [ fhir:value "Social history" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "72166-2" ] ; | |
| fhir:Coding.display [ fhir:value "Tobacco smoking status" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Tobacco smoking status" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2015-03-27T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:e0623eab-bc78-461e-cb51-4cdf6916360e" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value "2015-03-27T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8517006" ] ; | |
| fhir:Coding.display [ fhir:value "Ex-smoker (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Ex-smoker (finding)" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 1 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" | |
| ] ; | |
| fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus" | |
| ] | |
| ] . | |
| <urn:uuid:ae0f13c4-ba4d-853d-deb5-eca39448a714> | |
| rdf:type fhir:DiagnosticReport ; | |
| fhir:DiagnosticReport.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:DiagnosticReport.effectiveDateTime | |
| [ fhir:value "2024-06-18T13:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:8b1ddb2f-d0a3-73b0-f0f0-b53d08409bcd" ] | |
| ] ; | |
| fhir:DiagnosticReport.issued [ fhir:value | |
| "2024-06-18T13:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.performer | |
| [ fhir:Reference.display [ fhir:value "Dr. Eldora89 Langosh790" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.presentedForm | |
| [ fhir:Attachment.contentType [ fhir:value | |
| "text/plain; charset=utf-8" ] ; | |
| fhir:Attachment.data [ fhir:value | |
| "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" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.status [ fhir:value | |
| "final" ] ; | |
| fhir:DiagnosticReport.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" | |
| ] | |
| ] . | |
| <urn:uuid:40f65893-36e3-7990-ac9d-d5e5715573eb> | |
| rdf:type fhir:Procedure ; | |
| fhir:Procedure.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "171207006" ] ; | |
| fhir:Coding.display [ fhir:value "Depression screening (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Depression screening (procedure)" ] | |
| ] ; | |
| fhir:Procedure.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Procedure.location [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:Procedure.performedPeriod [ fhir:Period.end [ fhir:value "2021-04-10T01:32:42-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-10T01:20:20-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Procedure.status [ fhir:value | |
| "completed" ] ; | |
| fhir:Procedure.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" | |
| ] | |
| ] . | |
| <urn:uuid:9bbbca28-d1d6-1306-92c3-00218e582368> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "39156-5" ] ; | |
| fhir:Coding.display [ fhir:value "Body mass index (BMI) [Ratio]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Body mass index (BMI) [Ratio]" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2017-03-31T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "kg/m2" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "kg/m2" ] ; | |
| fhir:Quantity.value [ fhir:value 27.84 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" | |
| ] | |
| ] . | |
| <urn:uuid:62d20363-e046-1ba0-b646-62c56df447f5> | |
| rdf:type fhir:Condition ; | |
| fhir:Condition.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "encounter-diagnosis" ] ; | |
| fhir:Coding.display [ fhir:value "Encounter Diagnosis" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Condition.clinicalStatus [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "active" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-clinical"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Condition.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "278860009" ] ; | |
| fhir:Coding.display [ fhir:value "Chronic low back pain (finding)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Chronic low back pain (finding)" ] | |
| ] ; | |
| fhir:Condition.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:236af474-49fb-8892-d08f-accafdd535c8" ] | |
| ] ; | |
| fhir:Condition.onsetDateTime [ fhir:value | |
| "2014-02-02T22:45:06-05:00"^^xsd:dateTime ] ; | |
| fhir:Condition.recordedDate [ fhir:value | |
| "2014-02-02T22:45:06-05:00"^^xsd:dateTime ] ; | |
| fhir:Condition.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Condition.verificationStatus | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "confirmed" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-ver-status"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" | |
| ] | |
| ] . | |
| <urn:uuid:7cbac7d2-bb11-615a-029b-3ca4c33cd9b9> | |
| rdf:type fhir:Procedure ; | |
| fhir:Procedure.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "710841007" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of anxiety (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of anxiety (procedure)" ] | |
| ] ; | |
| fhir:Procedure.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Procedure.location [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:Procedure.performedPeriod [ fhir:Period.end [ fhir:value "2021-04-10T00:43:45-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-04-10T00:17:48-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Procedure.status [ fhir:value | |
| "completed" ] ; | |
| fhir:Procedure.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" | |
| ] | |
| ] . | |
| <urn:uuid:b87f05e4-fc32-02b5-310d-7edd1e823068> | |
| rdf:type fhir:DiagnosticReport ; | |
| fhir:DiagnosticReport.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "76499-3" ] ; | |
| fhir:Coding.display [ fhir:value "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" ] | |
| ] ; | |
| fhir:DiagnosticReport.effectiveDateTime | |
| [ fhir:value "2017-04-01T01:08:36-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] | |
| ] ; | |
| fhir:DiagnosticReport.issued [ fhir:value | |
| "2017-04-01T01:08:36.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.result [ fhir:Reference.display [ fhir:value "Total score [HARK]" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:a8bf8c8e-d101-36d8-c2e1-782e5f40d02c" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.status [ fhir:value | |
| "final" ] ; | |
| fhir:DiagnosticReport.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] . | |
| <urn:uuid:48d79c9b-6bb9-9169-0862-c2484506742a> | |
| rdf:type fhir:MedicationRequest ; | |
| fhir:MedicationRequest.authoredOn | |
| [ fhir:value "2015-08-24T00:09:56-04:00"^^xsd:dateTime ] ; | |
| fhir:MedicationRequest.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "community" ] ; | |
| fhir:Coding.display [ fhir:value "Community" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/medicationrequest-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Community" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:MedicationRequest.dosageInstruction | |
| [ fhir:Dosage.asNeededBoolean [ fhir:value | |
| true ] ; | |
| fhir:Dosage.sequence [ fhir:value | |
| "1" ] ; | |
| fhir:Dosage.text [ fhir:value | |
| "Take as needed." ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:MedicationRequest.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:a2a0afbe-5c77-c45a-7fcd-e62cc76d2a9d" ] | |
| ] ; | |
| fhir:MedicationRequest.intent [ fhir:value | |
| "order" ] ; | |
| fhir:MedicationRequest.medicationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "313782" ] ; | |
| fhir:Coding.display [ fhir:value "Acetaminophen 325 MG Oral Tablet" ] ; | |
| fhir:Coding.system [ fhir:value "http://www.nlm.nih.gov/research/umls/rxnorm"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Acetaminophen 325 MG Oral Tablet" ] | |
| ] ; | |
| fhir:MedicationRequest.requester | |
| [ fhir:Reference.display [ fhir:value "Dr. Emma804 Larkin917" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883090" ] | |
| ] ; | |
| fhir:MedicationRequest.status [ fhir:value | |
| "stopped" ] ; | |
| fhir:MedicationRequest.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" | |
| ] | |
| ] . | |
| <urn:uuid:c4bce2b8-a11b-8018-76da-55c30ea96db8> | |
| rdf:type fhir:DocumentReference ; | |
| fhir:DocumentReference.author [ fhir:Reference.display [ fhir:value "Dr. Alejandra902 Thompson596" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "clinical-note" ] ; | |
| fhir:Coding.display [ fhir:value "Clinical Note" ] ; | |
| fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.content [ fhir:DocumentReference.content.attachment | |
| [ fhir:Attachment.contentType [ fhir:value | |
| "text/plain; charset=utf-8" ] ; | |
| fhir:Attachment.data [ fhir:value | |
| "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" ] | |
| ] ; | |
| fhir:DocumentReference.content.format | |
| [ fhir:Coding.code [ fhir:value "urn:ihe:iti:xds:2017:mimeTypeSufficient" ] ; | |
| fhir:Coding.display [ fhir:value "mimeType Sufficient" ] ; | |
| fhir:Coding.system [ fhir:value "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode"^^xsd:anyURI ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.context [ fhir:DocumentReference.context.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:4b5f69fb-f3a7-07f6-b476-1ad9fbce6381" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.context.period | |
| [ fhir:Period.end [ fhir:value "1993-05-15T00:19:44-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "1993-05-14T23:45:06-04:00"^^xsd:dateTime ] | |
| ] | |
| ] ; | |
| fhir:DocumentReference.custodian | |
| [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Organization?identifier=https://github.com/synthetichealth/synthea|ace1ac31-036a-38fd-b451-b3b87157c717" ] | |
| ] ; | |
| fhir:DocumentReference.date [ fhir:value | |
| "1993-05-14T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DocumentReference.identifier | |
| [ fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "urn:uuid:bc4ddb26-8da1-dec4-1d9b-8ce441982273" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DocumentReference.status [ fhir:value | |
| "superseded" ] ; | |
| fhir:DocumentReference.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:DocumentReference.type [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" | |
| ] | |
| ] . | |
| <urn:uuid:5a6d828a-595b-0821-4d5a-13724d417a65> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "72514-3" ] ; | |
| fhir:Coding.display [ fhir:value "Pain severity - 0-10 verbal numeric rating [Score] - Reported" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Pain severity - 0-10 verbal numeric rating [Score] - Reported" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2023-04-14T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:9c748b35-c9f0-6c85-47af-4434fa1ba3d1" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2023-04-14T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "{score}" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "{score}" ] ; | |
| fhir:Quantity.value [ fhir:value "2"^^xsd:decimal ] | |
| ] . | |
| <urn:uuid:e5dd2d61-06aa-d50e-8773-e48606465968> | |
| rdf:type fhir:Procedure ; | |
| fhir:Procedure.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "428211000124100" ] ; | |
| fhir:Coding.display [ fhir:value "Assessment of substance use (procedure)" ] ; | |
| fhir:Coding.system [ fhir:value "http://snomed.info/sct"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Assessment of substance use (procedure)" ] | |
| ] ; | |
| fhir:Procedure.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:9c748b35-c9f0-6c85-47af-4434fa1ba3d1" ] | |
| ] ; | |
| fhir:Procedure.location [ fhir:Reference.display [ fhir:value "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC" ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|54f6e0ea-130a-3704-91e9-4cfb7b0a64b7" ] | |
| ] ; | |
| fhir:Procedure.performedPeriod [ fhir:Period.end [ fhir:value "2023-04-15T00:47:03-04:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2023-04-15T00:35:12-04:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:Procedure.status [ fhir:value | |
| "completed" ] ; | |
| fhir:Procedure.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" | |
| ] | |
| ] . | |
| <urn:uuid:842e8426-8b2c-5e2c-69c7-60c27687b952> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "85354-9" ] ; | |
| fhir:Coding.display [ fhir:value "Blood pressure panel with all children optional" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Blood pressure panel with all children optional" ] | |
| ] ; | |
| fhir:Observation.component [ fhir:Observation.component.code | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8462-4" ] ; | |
| fhir:Coding.display [ fhir:value "Diastolic Blood Pressure" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Diastolic Blood Pressure" ] | |
| ] ; | |
| fhir:Observation.component.valueQuantity | |
| [ fhir:Quantity.code [ fhir:value "mm[Hg]" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "mm[Hg]" ] ; | |
| fhir:Quantity.value [ fhir:value "78"^^xsd:decimal ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.component [ fhir:Observation.component.code | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8480-6" ] ; | |
| fhir:Coding.display [ fhir:value "Systolic Blood Pressure" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Systolic Blood Pressure" ] | |
| ] ; | |
| fhir:Observation.component.valueQuantity | |
| [ fhir:Quantity.code [ fhir:value "mm[Hg]" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "mm[Hg]" ] ; | |
| fhir:Quantity.value [ fhir:value "137"^^xsd:decimal ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2019-04-05T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f466d2cb-3b48-2fe4-99dd-2e31fee1e1b8" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value "2019-04-05T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" | |
| ] | |
| ] . | |
| <urn:uuid:d1b2f4d6-9df9-afcb-eaaf-cfc75366ae18> | |
| rdf:type fhir:DiagnosticReport ; | |
| fhir:DiagnosticReport.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "82666-9" ] ; | |
| fhir:Coding.display [ fhir:value "Drug Abuse Screening Test-10 [DAST-10]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Drug Abuse Screening Test-10 [DAST-10]" ] | |
| ] ; | |
| fhir:DiagnosticReport.effectiveDateTime | |
| [ fhir:value "2023-04-15T01:12:25-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:9c748b35-c9f0-6c85-47af-4434fa1ba3d1" ] | |
| ] ; | |
| fhir:DiagnosticReport.issued [ fhir:value | |
| "2023-04-15T01:12:25.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.result [ fhir:Reference.display [ fhir:value "Total score [DAST-10]" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:a8455910-d5a1-d86a-84d4-bb6d6b6f6601" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.status [ fhir:value | |
| "final" ] ; | |
| fhir:DiagnosticReport.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] . | |
| <urn:uuid:85d92f18-97ac-be45-778a-133825fe906b> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8302-2" ] ; | |
| fhir:Coding.display [ fhir:value "Body Height" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Body Height" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2017-03-31T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "cm" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "cm" ] ; | |
| fhir:Quantity.value [ fhir:value 169.1 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" | |
| ] | |
| ] . | |
| <urn:uuid:6b8c4a86-10c0-4184-61cf-f8e75e71ff38> | |
| rdf:type fhir:DiagnosticReport ; | |
| fhir:DiagnosticReport.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "51847-2" ] ; | |
| fhir:Coding.display [ fhir:value "Evaluation + Plan note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "34117-2" ] ; | |
| fhir:Coding.display [ fhir:value "History and physical note" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:DiagnosticReport.effectiveDateTime | |
| [ fhir:value "2017-03-31T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:f5905252-4632-bfbb-5a7d-b008f73e6951" ] | |
| ] ; | |
| fhir:DiagnosticReport.issued [ fhir:value | |
| "2017-03-31T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.performer | |
| [ fhir:Reference.display [ fhir:value "Dr. Alejandra902 Thompson596" ] ; | |
| fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999979096" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.presentedForm | |
| [ fhir:Attachment.contentType [ fhir:value | |
| "text/plain; charset=utf-8" ] ; | |
| fhir:Attachment.data [ fhir:value | |
| "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" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.status [ fhir:value | |
| "final" ] ; | |
| fhir:DiagnosticReport.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" | |
| ] | |
| ] . | |
| <urn:uuid:fee7ab82-68fb-8b86-5955-68e067c9934c> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "survey" ] ; | |
| fhir:Coding.display [ fhir:value "Survey" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "70274-6" ] ; | |
| fhir:Coding.display [ fhir:value "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2021-04-10T00:43:45-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2021-04-10T00:43:45.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "{score}" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "{score}" ] ; | |
| fhir:Quantity.value [ fhir:value "2"^^xsd:decimal ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" | |
| ] | |
| ] . | |
| <urn:uuid:6e154b61-ce4a-ac31-a5e9-2bb2b4a7431e> | |
| rdf:type fhir:Observation ; | |
| fhir:Observation.category [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "vital-signs" ] ; | |
| fhir:Coding.display [ fhir:value "Vital signs" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/observation-category"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Observation.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "8302-2" ] ; | |
| fhir:Coding.display [ fhir:value "Body Height" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Body Height" ] | |
| ] ; | |
| fhir:Observation.effectiveDateTime | |
| [ fhir:value "2021-04-09T23:45:06-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.encounter [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:Observation.issued [ fhir:value | |
| "2021-04-09T23:45:06.960-04:00"^^xsd:dateTime ] ; | |
| fhir:Observation.status [ fhir:value | |
| "final" ] ; | |
| fhir:Observation.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Observation.valueQuantity [ fhir:Quantity.code [ fhir:value "cm" ] ; | |
| fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org"^^xsd:anyURI ] ; | |
| fhir:Quantity.unit [ fhir:value "cm" ] ; | |
| fhir:Quantity.value [ fhir:value 169.1 ] | |
| ] ; | |
| fhir:Resource.meta [ fhir:Meta.profile [ fhir:index 0 ; | |
| fhir:value "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" | |
| ] | |
| ] . | |
| <urn:uuid:2464d942-682a-1db2-51b8-fb6a29621e8e> | |
| rdf:type fhir:DiagnosticReport ; | |
| fhir:DiagnosticReport.code [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "76499-3" ] ; | |
| fhir:Coding.display [ fhir:value "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" ] ; | |
| fhir:Coding.system [ fhir:value "http://loinc.org"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:CodeableConcept.text [ fhir:value | |
| "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" ] | |
| ] ; | |
| fhir:DiagnosticReport.effectiveDateTime | |
| [ fhir:value "2021-04-10T01:20:20-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.encounter | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:aa03ef7b-ba54-acb7-cbbb-0628bfbb5911" ] | |
| ] ; | |
| fhir:DiagnosticReport.issued [ fhir:value | |
| "2021-04-10T01:20:20.960-04:00"^^xsd:dateTime ] ; | |
| fhir:DiagnosticReport.result [ fhir:Reference.display [ fhir:value "Total score [HARK]" ] ; | |
| fhir:Reference.reference [ fhir:value "urn:uuid:d281a076-abe1-a2e3-6347-e9d7568811d6" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:DiagnosticReport.status [ fhir:value | |
| "final" ] ; | |
| fhir:DiagnosticReport.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] . | |
| <urn:uuid:788090d7-4b84-5eec-a5d4-1b72af00825d> | |
| rdf:type fhir:ExplanationOfBenefit ; | |
| fhir:DomainResource.contained [ rdf:type fhir:Coverage ; | |
| fhir:Coverage.beneficiary [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:Coverage.payor [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:Coverage.status [ fhir:value "active" ] ; | |
| fhir:Coverage.type [ fhir:CodeableConcept.text [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:Resource.id [ fhir:value "coverage" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:DomainResource.contained [ rdf:type fhir:ServiceRequest ; | |
| fhir:Resource.id [ fhir:value | |
| "referral" ] ; | |
| fhir:ServiceRequest.intent [ fhir:value | |
| "order" ] ; | |
| fhir:ServiceRequest.performer [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ServiceRequest.requester [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] | |
| ] ; | |
| fhir:ServiceRequest.status [ fhir:value | |
| "completed" ] ; | |
| fhir:ServiceRequest.subject [ fhir:Reference.reference [ fhir:value "urn:uuid:cb6aca68-e6a3-ee70-5876-9f255c3eac48" ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.billablePeriod | |
| [ fhir:Period.end [ fhir:value "2022-01-15T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:Period.start [ fhir:value "2021-01-15T23:00:06-05:00"^^xsd:dateTime ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam | |
| [ fhir:ExplanationOfBenefit.careTeam.provider | |
| [ fhir:Reference.reference [ fhir:value "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999997296" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.role | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "primary" ] ; | |
| fhir:Coding.display [ fhir:value "Primary provider" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claimcareteamrole"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.careTeam.sequence | |
| [ fhir:value "1" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.claim | |
| [ fhir:Reference.reference [ fhir:value "urn:uuid:f3380f2d-4278-ff7d-89bb-b091c4ec0a3a" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.created | |
| [ fhir:value "2021-01-15T23:00:06-05:00"^^xsd:dateTime ] ; | |
| fhir:ExplanationOfBenefit.facility | |
| [ fhir:Reference.display [ fhir:value "BRIGHAM AND WOMEN'S FAULKNER HOSPITAL, INC." ] ; | |
| fhir:Reference.reference [ fhir:value "Location?identifier=https://github.com/synthetichealth/synthea|879680f0-7d30-38dc-8476-145aa229a0c4" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/clm_id"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "f3380f2d-4278-ff7d-89bb-b091c4ec0a3a" ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.identifier | |
| [ fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/identifier/claim-group"^^xsd:anyURI ] ; | |
| fhir:Identifier.value [ fhir:value "99999999999" ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance | |
| [ fhir:ExplanationOfBenefit.insurance.coverage | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] ; | |
| fhir:Reference.reference [ fhir:value "#coverage" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurance.focal | |
| [ fhir:value true ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.insurer | |
| [ fhir:Reference.display [ fhir:value "Medicare" ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item [ fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Allowed Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 3 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd" ] ; | |
| fhir:Coding.display [ fhir:value "Line Processing Indicator Code" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 5 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 136.00 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Submitted Charge Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 2 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 108.80000000000001 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Provider Payment Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 1 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value "0"^^xsd:decimal ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Part B Deductible Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 4 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication | |
| [ fhir:ExplanationOfBenefit.item.adjudication.amount | |
| [ fhir:Money.currency [ fhir:value "USD" ] ; | |
| fhir:Money.value [ fhir:value 27.200000000000003 ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.adjudication.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt" ] ; | |
| fhir:Coding.display [ fhir:value "Line Beneficiary Coinsurance Amount" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/adjudication"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:index 0 | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.category | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "1" ] ; | |
| fhir:Coding.display [ fhir:value "Medical care" ] ; | |
| fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.informationSequence | |
| [ fhir:index 0 ; | |
| fhir:value "1" | |
| ] ; | |
| fhir:ExplanationOfBenefit.item.locationCodeableConcept | |
| [ fhir:CodeableConcept.coding [ fhir:Coding.code [ fhir:value "21" ] ; | |
| fhir:Coding.display [ fhir:value "Inpatient Hospital" ] ; | |
| fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ; | |
| fhir:index 0 | |
| ] | |
| ] ; | |
| fhir:ExplanationOfBen |
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