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masnick/kiln_fhir_bundle.json

Created March 8, 2026 16:02
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Synthetic FHIR bundle generated by https://github.com/jmandel/kiln for "52m with chronic kidney disease". MITRE: Approved for Public Release / Case #25-3098.
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kiln_fhir_bundle.json
{
"resourceType": "Bundle",
"type": "document",
"id": "bundle-2772d3dd",
"timestamp": "2026-03-08T14:33:03.975Z",
"identifier": {
"value": "composition-c6b0588b",
"system": "https://kiln.fhir.me/Bundle"
},
"entry": [
{
"fullUrl": "https://kiln.fhir.me/Composition/composition-c6b0588b",
"resource": {
"resourceType": "Composition",
"status": "final",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "60591-5",
"display": "Patient summary Document"
}
]
},
"subject": {
"reference": "Patient/pat-1",
"display": "Patient with chronic kidney disease evaluation"
},
"encounter": {
"reference": "Encounter/enc-1",
"display": "Outpatient nephrology visit for CKD assessment and dialysis planning"
},
"date": "2023-09-15T10:30:00Z",
"author": [
{
"reference": "Practitioner/pract-1",
"display": "Dr. Jane Doe, Nephrologist"
}
],
"title": "CKD Assessment Summary",
"section": [
{
"title": "Chief Complaint",
"text": {
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>The patient’s chief complaint is a three‑month history of progressive fatigue, markedly reduced urine output, and new bilateral lower‑extremity edema described as “puffy ankles” and “tight shoes.” He adheres to a 1.5‑L daily fluid restriction but reports increasing thirst despite limiting intake, which he relieves with occasional sips of water and ice chips. He experiences intermittent nausea after meals, especially with protein‑rich foods, without vomiting or abdominal pain. He denies chest discomfort, dyspnea, cough, fever, dysuria, or hematuria. Energy has declined to the point that he must pause during routine activities such as climbing a flight of stairs or walking his dog because of a heavy feeling in his legs. Physical exam reveals 1+ pitting edema of the shins and a 3 kg weight gain since his last outpatient visit. Laboratory work from three weeks ago showed serum creatinine 3.2 mg/dL, BUN 58 mg/dL, and hemoglobin 9.8 g/dL, consistent with advancing renal insufficiency.</p></div>",
"status": "additional"
}
},
{
"title": "History of Present Illness",
"text": {
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>The patient reports a steady decline in renal function over the past three months, accompanied by oliguria, peripheral edema, and worsening fatigue. He notes that his urine volume has markedly decreased, often producing only a few milliliters at night, and he feels incomplete voiding, prompting frequent bathroom trips. Despite strict fluid restriction, he describes an unquenchable thirst that is only partially relieved by small sips of water and ice chips. Post‑prandial nausea has become more frequent, particularly after larger protein portions, though he does not vomit. His energy level has fallen such that he must stop during a flight of stairs or while walking his dog because his legs feel “heavy and lead‑filled.”</p>\n<p>Physical examination demonstrates 1+ pitting edema of the shins and a 3 kg weight gain since the prior visit. Laboratory studies obtained three weeks ago revealed serum creatinine 4.8 mg/dL, BUN 58 mg/dL, hemoglobin 9.8 g/dL, and an estimated glomerular filtration rate &lt; 15 mL/min/1.73 m², confirming progression to stage 5 chronic kidney disease. He is currently on lisinopril 20 mg daily (blood pressure 158/92 mmHg), sevelamer 800 mg three times daily, calcium acetate 667 mg three times daily, and receives subcutaneous epoetin alfa for anemia. Metformin has been discontinued, and he reports occasional alcohol use on weekends. He denies dysuria, hematuria, fever, or recent infections but remains concerned that these symptoms signal worsening kidney function and the potential need for dialysis.</p></div>",
"status": "additional"
}
},
{
"title": "Past Medical & Surgical History",
"text": {
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>The patient’s medical history includes essential hypertension diagnosed at age 45, managed with lisinopril 20 mg daily and amlodipine 5 mg daily; blood pressure remains suboptimally controlled. He was diagnosed with type 2 diabetes mellitus at age 48, previously treated with metformin and glipizide, but metformin was discontinued due to declining renal function. In 2018 he suffered an anterior‑wall myocardial infarction and underwent percutaneous coronary intervention with drug‑eluting stent placement; he now takes low‑dose aspirin 81 mg daily and high‑intensity atorvastatin 40 mg nightly for secondary prevention. Chronic peripheral neuropathy related to diabetic microvascular injury manifests as numbness and diminished vibration sense in the feet, requiring routine foot inspections. He had an uncomplicated appendectomy at age 22. No prior episodes of dialysis or transplantation are recorded.</p>\n<p>Renal laboratory profile demonstrates persistent hyperphosphatemia (phosphate 6.2 mg/dL), secondary hyperparathyroidism (intact PTH 210 pg/mL), normal calcium (8.1 mg/dL), and anemia (hemoglobin 9.8 g/dL). Lipid studies show elevated LDL‑cholesterol (138 mg/dL) and triglycerides (210 mg/dL) despite high‑intensity statin therapy. No prior acute kidney injury is documented, underscoring the urgency of evaluating renal replacement options before further decompensation.</p></div>",
"status": "additional"
},
"entry": [
{
"reference": "Condition/htn-1"
},
{
"reference": "Condition/diabetes-1"
},
{
"reference": "Condition/mi-1"
},
{
"reference": "Procedure/pci-1"
},
{
"reference": "Condition/neuropathy-1"
},
{
"reference": "Procedure/appendectomy-1"
},
{
"reference": "MedicationStatement/ms-lisinopril-1"
},
{
"reference": "MedicationStatement/ms-sevelamer-1"
},
{
"reference": "MedicationStatement/ms-calcium-acetate-1"
},
{
"reference": "MedicationStatement/ms-atorvastatin-1"
},
{
"reference": "MedicationStatement/ms-epoetin-1"
}
]
},
{
"title": "Assessment",
"text": {
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>The patient meets criteria for end‑stage renal disease (ESRD) with an estimated glomerular filtration rate persistently &lt;15 mL/min/1.73 m², evidenced by serum creatinine 4.8 mg/dL, BUN 58 mg/dL, and hemoglobin 9.8 g/dL secondary to renal‑mediated anemia. His uncontrolled hypertension (BP 158/92 mmHg on lisinopril 20 mg daily) and progressive peripheral edema reflect volume overload and activation of the renin‑angiotensin system, placing him at high risk for cardiovascular events despite optimal lipid management (LDL 138 mg/dL on atorvastatin 40 mg nightly). </p>\n<p>Uremic symptoms are evident in intermittent post‑prandial nausea, early satiety, and recent 3 kg weight gain due to fluid retention. Laboratory evaluation reveals secondary hyperparathyroidism (intact PTH 210 pg/mL), hyperphosphatemia (6.2 mg/dL) with normal calcium (8.1 mg/dL), and metabolic acidosis on recent BMP, necessitating phosphate‑binding therapy (sevelamer 800 mg TID, calcium acetate 667 mg TID) and vitamin D analog supplementation. Nutritional status is compromised, with hypoalbuminemia (albumin 3.2 g/dL) suggesting protein‑energy wasting, highlighting the need for targeted dietary counseling and supplementation prior to dialysis initiation.</p>\n<p>Given the convergence of worsening renal parameters, refractory hypertension, and symptomatic uremia, early referral for dialysis planning is warranted. The assessment recommends a multidisciplinary discussion to determine optimal timing and modality (hemodialysis vs. peritoneal dialysis), address anemia with erythropoiesis‑stimulating agents, manage bone mineral disorder, and assess psychosocial readiness for renal replacement therapy. Prompt intervention is expected to stabilize volume status, correct metabolic derangements, and preserve residual renal function, thereby improving overall prognosis and quality of life.</p></div>",
"status": "additional"
},
"entry": [
{
"reference": "Condition/esrd-1"
},
{
"reference": "DiagnosticReport/report-labs-1"
},
{
"reference": "Observation/obs-creatinine-1"
},
{
"reference": "Observation/obs-bun-1"
},
{
"reference": "Observation/obs-hemoglobin-1"
},
{
"reference": "Observation/obs-phosphate-1"
},
{
"reference": "Observation/obs-calcium-1"
},
{
"reference": "Observation/obs-PTH-1"
},
{
"reference": "Observation/obs-albumin-1"
},
{
"reference": "Observation/obs-LDL-1"
},
{
"reference": "Observation/obs-TG-1"
}
]
},
{
"title": "Plan",
"text": {
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>The patient will be referred to the nephrology service for comprehensive dialysis modality counseling within the next 48 hours, emphasizing shared decision‑making regarding in‑center hemodialysis versus home peritoneal dialysis based on work schedule, transportation access, and psychosocial readiness. Antihypertensive therapy will be optimized by increasing lisinopril to 40 mg daily pending a repeat BMP in two weeks, with a target systolic blood pressure &lt;130 mmHg; amlodipine will be titrated to 10 mg daily if BP remains &gt;140/90 mmHg on the higher ACE‑inhibitor dose.</p>\n<p>Anemia management will commence with a target hemoglobin of 10–11 g/dL using subcutaneous epoetin alfa 40 units weekly, with iron studies (transferrin saturation &gt; 30 %, ferritin &gt; 200 ng/mL) to guide intravenous iron supplementation if needed. Phosphate binders will be reinforced: sevelamer 800 mg three times daily with each main meal and calcium acetate 667 mg three times daily for breakthrough hyperphosphatemia, aiming for serum phosphate &lt; 5.5 mg/dL. Vitamin D analog therapy (calcitriol 0.25 µg daily) will be started to address secondary hyperparathyroidism, with repeat calcium‑phosphate product monitoring every four weeks.</p>\n<p>Fluid restriction will be reinforced to 1.5 L/day, with daily weight checks; any gain &gt;0.5 kg will prompt diuretic adjustment (furosemide 40 mg IV bolus followed by oral titration as needed). Dietary counseling will address protein intake (1.2 g/kg/day), potassium restriction (&lt; 2,000 mg/day), and encourage oral nutritional supplements to correct hypoalbuminemia (target albumin &gt; 3.5 g/dL). </p>\n<p>Patient education will include a concise dialysis orientation covering vascular access placement, session logistics, and infection‑prevention measures, as well as a transplant evaluation pathway if residual renal function stabilizes. A follow‑up visit is scheduled in four weeks to review labs (creatinine, BUN, phosphate, PTH, hemoglobin, potassium), reassess volume status, and discuss psychosocial support resources; interim labs will be obtained 10 days after dialysis initiation to monitor electrolytes and anemia response. The plan aims to stabilize metabolic derangements, prepare for renal replacement therapy, and preserve residual renal function to improve overall quality of life.</p></div>",
"status": "additional"
},
"entry": [
{
"reference": "ServiceRequest/dialysis-referral-1"
},
{
"reference": "ServiceRequest/bp-optimization-1"
},
{
"reference": "ServiceRequest/anemia-management-1"
},
{
"reference": "ServiceRequest/phosphate-binding-1"
},
{
"reference": "ServiceRequest/vitaminD-1"
},
{
"reference": "ServiceRequest/dietary-counseling-1"
},
{
"reference": "MedicationRequest/atorvastatin-1"
},
{
"reference": "MedicationRequest/lisinopril-1"
},
{
"reference": "MedicationRequest/sevelamer-1"
},
{
"reference": "MedicationRequest/calcium-acetate-1"
},
{
"reference": "MedicationStatement/epoetin-1"
},
{
"reference": "Observation/vital-weight-1"
},
{
"reference": "Observation/vital-bp-1"
},
{
"reference": "Observation/vital-edema-1"
}
]
}
],
"id": "composition-c6b0588b",
"identifier": {
"value": "composition-c6b0588b",
"system": "https://kiln.fhir.me/Composition"
}
}
},
{
"fullUrl": "https://kiln.fhir.me/Condition/htn-1",
"resource": {
"resourceType": "Condition",
"id": "htn-1",
"subject": {
"reference": "Patient/pat-1"
},
"encounter": {
"reference": "Encounter/enc-1"
},
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active",
"display": "Active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed",
"display": "Confirmed"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "problem-list-item",
"display": "Problem List Item"
}
]
}
],
"code": {
"text": "Hypertension"
},
"onsetDateTime": "2023-01-01"
}
},
{
"fullUrl": "https://kiln.fhir.me/Condition/diabetes-1",
"resource": {
"resourceType": "Condition",
"id": "diabetes-1",
"subject": {
"reference": "Patient/pat-1"
},
"encounter": {
"reference": "Encounter/enc-1"
},
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active",
"display": "Active"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "problem-list-item",
"display": "Problem List Item"
}
]
}
],
"code": {
"text": "Type 2 Diabetes Mellitus"
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed",
"display": "Confirmed"
}
]
}
}
},
{
"fullUrl": "https://kiln.fhir.me/Condition/mi-1",
"resource": {
"resourceType": "Condition",
"id": "mi-1",
"subject": {
"reference": "Patient/pat-1"
},
"encounter": {
"reference": "Encounter/enc-1"
},
"code": {
"coding": [
{
"system": "http://dicom.nema.org/resources/ontology/DCM",
"code": "122170",
"display": "Type of Myocardial Infarction"
}
],
"text": "Myocardial infarction, anterior wall"
},
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active",
"display": "Active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed",
"display": "Confirmed"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "problem-list-item",
"display": "Problem List Item"
}
]
}
],
"onsetDateTime": "2023-06-15"
}
},
{
"fullUrl": "https://kiln.fhir.me/Procedure/pci-1",
"resource": {
"resourceType": "Procedure",
"id": "pci-1",
"status": "completed",
"code": {
"coding": [
{
"system": "http://dicom.nema.org/resources/ontology/DCM",
"code": "122061",
"display": "Percutaneous Coronary Intervention"
}
],
"text": "Percutaneous coronary intervention with drug-eluting stent"
},
"subject": {
"reference": "Patient/pat-1"
},
"encounter": {
"reference": "Encounter/enc-1"
},
"performer": [
{
"actor": {
"reference": "Practitioner/pract-1"
}
}
],
"performedDateTime": "2018-03-15",
"extension": [
{
"url": "urn:validation-status",
"valueString": "{\"validationErrors\":[{\"severity\":\"error\",\"code\":\"invalid\",\"details\":\"Object must have some content\",\"location\":\"Procedure.category\"}]}"
}
]
}
},
{
"fullUrl": "https://kiln.fhir.me/Condition/neuropathy-1",
"resource": {
"resourceType": "Condition",
"id": "neuropathy-1",
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active",
"display": "Active"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "problem-list-item",
"display": "Problem List Item"
}
]
}
],
"code": {
"text": "Peripheral neuropathy"
},
"subject": {
"reference": "Patient/pat-1"
},
"encounter": {
"reference": "Encounter/enc-1"
}
}
},
{
"fullUrl": "https://kiln.fhir.me/Procedure/appendectomy-1",
"resource": {
"resourceType": "Procedure",
"id": "appendectomy-1",
"status": "completed",
"category": {
"coding": [
{
"system": "http://dicom.nema.org/resources/ontology/DCM",
"code": "111410",
"display": "Surgical consult"
}
]
},
"code": {
"text": "Appendectomy"
},
"subject": {
"reference": "Patient/pat-1"
},
"encounter": {
"reference": "Encounter/enc-1"
},
"performer": [
{
"actor": {
"reference": "Practitioner/pract-1"
}
}
],
"performedDateTime": "2023-09-15T10:30:00Z",
"note": [
{
"text": "Appendectomy performed for acute appendicitis."
}
]
}
},
{
"fullUrl": "https://kiln.fhir.me/MedicationStatement/ms-lisinopril-1",
"resource": {
"resourceType": "MedicationStatement",
"id": "ms-lisinopril-1",
"status": "active",
"medicationReference": {
"reference": "Medication/ln-1",
"display": "Lisinopril"
},
"subject": {
"reference": "Patient/pat-1"
},
"dosage": [
{
"text": "20 mg daily",
"timing": {
"repeat": {
"frequency": 1,
"period": 1,
"periodUnit": "d"
}
},
"doseAndRate": [
{
"doseQuantity": {
"value": 20,
"unit": "mg",
"system": "http://unitsofmeasure.org",
"code": "mg"
}
}
]
}
]
}
},
{
"fullUrl": "https://kiln.fhir.me/MedicationStatement/ms-sevelamer-1",
"resource": {
"resourceType": "MedicationStatement",
"id": "ms-sevelamer-1",
"status": "active",
"medicationReference": {
"reference": "Medication/196999",
"display": "Sevelamer carbonate"
},
"subject": {
"reference": "Patient/pat-1"
},
"dosage": [
{
"text": "800 mg three times daily",
"timing": {
"repeat": {
"frequency": 3,
"period": 1,
"periodUnit": "d"
}
},
"doseAndRate": [
{
"doseQuantity": {
"value": 800,
"unit": "mg",
"system": "http://unitsofmeasure.org",
"code": "mg"
}
}
]
}
]
}
},
{
"fullUrl": "https://kiln.fhir.me/MedicationStatement/ms-calcium-acetate-1",
"resource": {
"resourceType": "MedicationStatement",
"id": "ms-calcium-acetate-1",
"status": "active",
"subject": {
"reference": "Patient/pat-1"
},
"dosage": [
{
"text": "667 mg three times daily",
"timing": {
"repeat": {
"frequency": 3,
"period": 1,
"periodUnit": "d"
}
},
"doseAndRate": [
{
"doseQuantity": {
"value": 667,
"unit": "mg",
"system": "http://unitsofmeasure.org",
"code": "mg"
}
}
]
}
],
"extension": [
{
"url": "urn:validation-status",
"valueString": "{\"validationErrors\":[{\"severity\":\"error\",\"code\":\"invalid\",\"details\":\"Object must have some content\",\"location\":\"MedicationStatement.medication[x]\"}]}"
}
]
}
},
{
"fullUrl": "https://kiln.fhir.me/MedicationStatement/ms-atorvastatin-1",
"resource": {
"resourceType": "MedicationStatement",
"id": "ms-atorvastatin-1",
"status": "active",
"medicationReference": {
"reference": "Medication/atorvastatin-1",
"display": "Atorvastatin 40 MG Tablet"
},
"subject": {
"reference": "Patient/pat-1"
},
"effectivePeriod": {
"start": "2023-01-01"
},
"dosage": [
{
"text": "40 mg at night",
"timing": {
"repeat": {
"frequency": 1,
"period": 1,
"periodUnit": "d"
}
},
"doseAndRate": [
{
"doseQuantity": {
"value": 40,
"unit": "mg",
"system": "http://unitsofmeasure.org",
"code": "mg"
}
}
]
}
]
}
},
{
"fullUrl": "https://kiln.fhir.me/MedicationStatement/ms-epoetin-1",
"resource": {
"resourceType": "MedicationStatement",
"id": "ms-epoetin-1",
"status": "active",
"medicationReference": {
"reference": "Medication/epoetin-alfa",
"display": "Epoetin alfa"
},
"subject": {
"reference": "Patient/pat-1"
},
"dosage": [
{
"text": "40 units subcutaneous weekly",
"timing": {
"repeat": {
"frequency": 1,
"period": 7,
"periodUnit": "d"
}
},
"doseAndRate": [
{
"doseQuantity": {
"value": 40,
"unit": "unit",
"system": "http://unitsofmeasure.org",
"code": "unit"
}
}
]
}
]
}
},
{
"fullUrl": "https://kiln.fhir.me/Condition/esrd-1",
"resource": {
"resourceType": "Condition",
"id": "esrd-1",
"subject": {
"reference": "Patient/pat-1"
},
"encounter": {
"reference": "Encounter/enc-1"
},
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active",
"display": "Active"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "problem-list-item",
"display": "Problem List Item"
}
]
}
],
"code": {
"text": "End-stage renal disease"
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed",
"display": "Confirmed"
}
]
},
"onsetDateTime": "2023-09-01"
}
},
{
"fullUrl": "https://kiln.fhir.me/DiagnosticReport/report-labs-1",
"resource": {
"resourceType": "DiagnosticReport",
"id": "report-labs-1",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB",
"display": "Laboratory"
}
]
}
],
"subject": {
"reference": "Patient/pat-1"
},
"encounter": {
"reference": "Encounter/enc-1"
},
"effectiveDateTime": "2023-09-28",
"issued": "2023-09-28T10:00:00Z",
"performer": [
{
"reference": "Organization/hospital-1",
"display": "General Hospital"
}
],
"result": [
{
"reference": "Observation/obs-creatinine-1",
"display": "Serum creatinine 4.8 mg/dL"
},
{
"reference": "Observation/obs-bun-1",
"display": "BUN 58 mg/dL"
},
{
"reference": "Observation/obs-hemoglobin-1",
"display": "Hb 9.8 g/dL"
},
{
"reference": "Observation/obs-phosphate-1",
"display": "Phosphate 6.2 mg/dL"
},
{
"reference": "Observation/obs-calcium-1",
"display": "Calcium 8.1 mg/dL"
},
{
"reference": "Observation/obs-PTH-1",
"display": "Intact PTH 210 pg/mL"
},
{
"reference": "Observation/obs-albumin-1",
"display": "Albumin 3.2 g/dL"
},
{
"reference": "Observation/obs-LDL-1",
"display": "LDL-C 138 mg/dL"
},
{
"reference": "Observation/obs-TG-1",
"display": "Triglycerides 210 mg/dL"
}
],
"extension": [
{
"url": "urn:validation-status",
"valueString": "{\"validationErrors\":[{\"severity\":\"error\",\"code\":\"invalid\",\"details\":\"Object must have some content\",\"location\":\"DiagnosticReport.code\"}]}"
}
]
}
},
{
"fullUrl": "https://kiln.fhir.me/Observation/obs-creatinine-1",
"resource": {
"resourceType": "Observation",
"id": "obs-creatinine-1",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
}
]
}
],
"subject": {
"reference": "Patient/pat-1"
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"valueString": "{\"validationErrors\":[{\"severity\":\"error\",\"code\":\"invalid\",\"details\":\"Array cannot be empty - the property should not be present if it has no values\",\"location\":\"Observation.component[0].code.coding\"},{\"severity\":\"error\",\"code\":\"invalid\",\"details\":\"Array cannot be empty - the property should not be present if it has no values\",\"location\":\"Observation.component[1].code.coding\"},{\"severity\":\"error\",\"code\":\"structure\",\"details\":\"Slice 'Observation.component:SystolicBP': a matching slice is required, but not found (from http://hl7.org/fhir/StructureDefinition/bp|4.0.1). Note that other slices are allowed in addition to this required slice\",\"location\":\"Observation\"},{\"severity\":\"error\",\"code\":\"structure\",\"details\":\"Slice 'Observation.component:DiastolicBP': a matching slice is required, but not found (from http://hl7.org/fhir/StructureDefinition/bp|4.0.1). Note that other slices are allowed in addition to this required slice\",\"location\":\"Observation\"}]}"
}
]
}
},
{
"fullUrl": "https://kiln.fhir.me/Observation/vital-edema-1",
"resource": {
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"id": "vital-edema-1",
"status": "final",
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{
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{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital Signs"
}
]
}
],
"subject": {
"reference": "Patient/pat-1"
},
"encounter": {
"reference": "Encounter/enc-1"
},
"effectiveDateTime": "2023-09-26T12:00:00Z",
"note": [
{
"text": "1+ pitting edema of shins"
}
],
"valueQuantity": {
"value": 1,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org"
},
"extension": [
{
"url": "urn:validation-status",
"valueString": "{\"validationErrors\":[{\"severity\":\"error\",\"code\":\"invalid\",\"details\":\"Object must have some content\",\"location\":\"Observation.code\"}]}"
}
]
}
},
{
"fullUrl": "https://kiln.fhir.me/Patient/pat-1",
"resource": {
"resourceType": "Patient",
"id": "pat-1",
"identifier": [
{
"system": "http://hospital.smarthealth.org/mrn",
"value": "PAT12345"
}
],
"name": [
{
"family": "Doe",
"given": [
"Patient"
]
}
],
"gender": "male",
"telecom": [
{
"system": "phone",
"value": "+1-555-123-4567",
"use": "home"
}
],
"address": [
{
"line": [
"123 Main St"
],
"city": "Anytown",
"state": "CA",
"postalCode": "12345",
"country": "USA"
}
],
"generalPractitioner": [
{
"reference": "Practitioner/pract-1"
}
]
}
},
{
"fullUrl": "https://kiln.fhir.me/Encounter/enc-1",
"resource": {
"resourceType": "Encounter",
"id": "enc-1",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB",
"display": "ambulatory"
},
"subject": {
"reference": "Patient/pat-1"
},
"identifier": [
{
"use": "official",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/identifier-use",
"code": "usual",
"display": "Usual"
}
]
},
"system": "http://hospital.org",
"value": "enc-1"
}
],
"period": {
"start": "2025-09-25T09:30:00-04:00",
"end": "2025-09-25T10:30:00-04:00"
}
}
},
{
"fullUrl": "https://kiln.fhir.me/Practitioner/pract-1",
"resource": {
"resourceType": "Practitioner",
"id": "pract-1",
"identifier": [
{
"use": "official",
"type": {
"text": "Practitioner Identifier"
},
"system": "http://hospital.org/practitioner-ids",
"value": "pract-1",
"period": {
"start": "2023-01-01"
},
"assigner": {
"display": "Hospital Health System"
}
}
],
"name": [
{
"use": "official",
"family": "Doe",
"given": [
"Jane"
],
"prefix": [
"Dr."
]
}
],
"telecom": [
{
"system": "email",
"value": "jane.doe@hospital.org",
"use": "work"
}
],
"gender": "female",
"birthDate": "1975-04-12"
}
}
]
}
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