Universal API Implementation Guide - Local Development build (v1.1.20) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Example Bundle: External - UAPI AS Enrollment: Xolair
Profile: UAPI Bundle - AS Enrollment
Bundle 04afa000-48a5-4fb2-8707-6a43af045868 of type message
Entry 1 - fullUrl = urn:uuid:9e592049-0434-48f9-8498-d7cf1e80e086
Resource MessageHeader:
Profile: UAPI MessageHeader
event: uapi-event-type enrollment-with-consent: enrollment-with-consent
Destinations
Name UAPI-ENR-V2.1 Sources
Name TailorMed
Entry 2 - fullUrl = urn:uuid:7cd8694a-0268-414e-b8ca-9271e7e1a242
Resource List:
messageContext
Mode: Change List Status: Current
Entry 3 - fullUrl = urn:uuid:ab45810f-2057-4b15-a24d-be929071cad5
Resource Patient:
Profile: UAPI Patient
Rudy Gandoff (official) Male, DoB: 1965-10-29 ( Patient internal identifier: TM-2345 (use: official, ))
Contact Detail
- ph: 6501231234(Home)
- ph: 6504561234(Mobile)
- rudyg@example.com
- 1234 Airport Blvd South San Francisco CA 94080 US
Language: English (preferred) Links:
- General Practitioner: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
- Managing Organization: Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Entry 4 - fullUrl = urn:uuid:7e45cd4c-8c11-4205-a2b7-fce834bc3511
Resource Organization:
Profile: UAPI Organization
identifier:
http://tailormed.co/HCP-01 (use: usual, )type: Healthcare Provider
name: TANNER CLINIC MURRAY
contact
telecom: venus@tannerclinic.com
address: 5296 S COMMERCE DR Murray UT 84107 US
contact
name: Venus Yardav (Official)
telecom: ph: 8882704882(Work), fax: 8179974042(Work)
Entry 5 - fullUrl = urn:uuid:3c5298d3-2b49-4f79-b703-a46623899258
Resource Practitioner:
Profile: UAPI Practitioner
identifier: National provider identifier/1659533669 (use: official, )
name: RAFAEL FIRSZT (Official)
Entry 6 - fullUrl = urn:uuid:42b41bdb-1781-49aa-a091-78cdd92129df
Resource Coverage:
Profile: UAPI Coverage
status: Active
type: health insurance plan policy
subscriberId: 4353
Classes
Type Value Name Group 12344frgr Group Number order: 1
network: Dakotacare
Entry 7 - fullUrl = urn:uuid:46d09721-f04e-4059-871f-31a1dc5127cf
Resource RelatedPerson:
Profile: UAPI RelatedPerson
relationship: significant other
name: Rebecca Gandoff (Official)
telecom: ph: 6504567890(Mobile)
birthDate: 1972-10-29
Entry 8 - fullUrl = urn:uuid:af15ccf2-4e36-400f-8e74-24fbcf29dfbd
Resource QuestionnaireResponse:
LinkID Text Definition Answer af15ccf2-4e36-400f-8e74-24fbcf29dfbd
Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234 authorization
Authorization # 3333333333 What is the Prescription Type? Naive/new start Does the patient have moderate to severe persistent allergic asthma? Yes Does the patient have a history of positive skin or RAST test to a perennial aeroallergen? Yes Does the patient have symptoms inadequately controlled with ICS? Yes Does the Patient have a clinical history consistent with IgE-mediated food allergy? No Site of Treatment Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500 Do not contact patient Yes What is the patient's IgE level (IU/mL)? 200 Anticipated Date of Treatment (Optional) 2024-04-30 Dispensing Through: Specialty Pharmacy Dispense: Prefilled Syringe C&R Ship To Site of Treatment Ok to leave a detailed message? Yes Has treatment started? Yes Place of Service Infusion Center Preferred Specialty Pharmacy (Optional) RX Crossroads Is prior authorization in place? Yes Is this a Prescription plan? No Re-verify benefits at PA expiration Yes Weight (kg) 50 TCPA Consent Provided? No Documentation for this format
Entry 9 - fullUrl = urn:uuid:bc20c5ea-f639-4221-ab61-ce75c5e64aba
Resource Condition:
code: Severe persistent asthma, uncomplicated
Entry 10 - fullUrl = urn:uuid:645c7756-d1d7-4df2-a65d-e1680dbbb991
Resource Consent:
Profile: UAPI Consent
status: Active
category: Patient Authorization Signature
provision
Entry 11 - fullUrl = urn:uuid:4f536bc9-a238-49ac-bf07-65d670f84ed3
Resource Consent:
Profile: UAPI Consent
status: Active
category: Prescriber Signature
provision
Entry 12 - fullUrl = urn:uuid:1cc390ba-32b3-4c41-a805-d4b9cee64784
Resource Provenance:
Profile: UAPI Provenance
Provenance for Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Summary
Recorded 2024-04-02 09:49:39+0000 Agents
who Bundle: identifier = Resource identifier: 6a7dbbed-6c6f-48b0-b32e-0a5d89dc72b2; type = message; timestamp = 2024-04-02 08:10:13-0500
Entry 13 - fullUrl = urn:uuid:212c57ad-45cd-4882-87e7-8415ded3db05
Resource ServiceRequest:
Profile: UAPI ServiceRequest
status: Active
intent: Order
code: Benefit Investigation / Prior Authorization
Entry 14 - fullUrl = urn:uuid:f71a66c4-f747-4b46-8adc-875a45f8ee7e
Resource ServiceRequest:
Profile: UAPI ServiceRequest
status: Active
intent: Order
code: Starter
Entry 15 - fullUrl = urn:uuid:e9d05dcd-bb02-4a08-af63-386dcab3f160
Resource MedicationRequest:
Profile: UAPI MedicationRequest
status: Active
intent: Order
courseOfTherapyType: Starter (Pre filled Syringe)
note:
Allergic Asthma - 300mg/dose every 2 weeks
dosageInstruction
timing: Once per 2 weeks
DoseAndRates
Dose[x] 300 mg dispenseRequest
UAPI MedicationRequest Dispenser Instructions:
Dispense Instruction: Quantity 5 of 300mg prefilled syringe(s), Quantity 2 of 75 mg prefilled syringe(s) and Quantity 1 of 150 mg prefilled syringe(s)
UAPI MedicationRequest Dispense Quantity Detailed Breakdown
- dispenseQuantity: 5
- dispenseUnit: 300mg prefilled syringe(s)
UAPI MedicationRequest Dispense Quantity Detailed Breakdown
- dispenseQuantity: 2
- dispenseUnit: 75mg prefilled syringe(s)
UAPI MedicationRequest Dispense Quantity Detailed Breakdown
- dispenseQuantity: 1
- dispenseUnit: 150 mg prefilled syringe(s)
numberOfRepeatsAllowed: 1
ExpectedSupplyDurations
Value Unit System Code 90 d http://unitsofmeasure.org d
Entry 16 - fullUrl = urn:uuid:d1654255-0a8d-4f2c-9405-19a6794500a2
Resource Organization:
Profile: UAPI Organization
identifier:
http://tailormed.co/PAY-200 (use: usual, )type: Insurance Company
name: Dakotacare
Contacts
Telecom ph: 8778472862(Work)
Entry 17 - fullUrl = urn:uuid:d1089cdf-7a5f-45b1-99b9-2c021eca5270
Resource Organization:
Profile: UAPI Organization
identifier:
http://SOT.com/ab/SOT-001 (use: usual, )type: Site of Treatment
name: FLORIDA HOSPITAL ORLANDO INFUSION CNTR
contact
telecom: ph: 4012704882(Work), fax: 4019974042(Work)
address: 2501 N ORANGE AVE, STE 481 Orlando FL 32804 US
contact
name: Vince Davis (Official)
telecom: ph: -unknown-