Universal API Implementation Guide
1.1.20 - ci-build

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

: External - UAPI AS Enrollment: Actemra Subcutaneous - JSON Representation

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{
  "resourceType" : "Bundle",
  "id" : "52d64634-22da-422b-81c0-9785c5e2bf15",
  "meta" : {
    "profile" : [
      🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-as-enrollment-bundle"
    ]
  },
  "identifier" : {
    "type" : {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
          "code" : "RI",
          "display" : "Resource identifier"
        }
      ]
    },
    "system" : "http://vendor.com/ab",
    "value" : "2ca5fcf4-9296-4712-81bd-f26c5a930eee",
    "assigner" : {
      "display" : "Alpha Beta"
    }
  },
  "type" : "message",
  "timestamp" : "2020-03-11T08:10:13-05:00",
  "entry" : [
    {
      "fullUrl" : "urn:uuid:684a5288-2bda-4d0b-8748-ea8c662be804",
      "resource" : {
        "resourceType" : "MessageHeader",
        "id" : "684a5288-2bda-4d0b-8748-ea8c662be804",
        "meta" : {
          "profile" : [
            🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_684a5288-2bda-4d0b-8748-ea8c662be804\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader 684a5288-2bda-4d0b-8748-ea8c662be804</b></p><a name=\"684a5288-2bda-4d0b-8748-ea8c662be804\"> </a><a name=\"hc684a5288-2bda-4d0b-8748-ea8c662be804\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-messageheader.html\">UAPI MessageHeader</a></p></div><p><b>event</b>: uapi-event-type enrollment-only: enrollment-only</p><h3>Destinations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td>UAPI-ENR-V2.1</td><td><a href=\"https://test-us-e1.apis.roche.com/pharma-cmg-ehr-fhir-exp-test/v2/enrollment\">https://test-us-e1.apis.roche.com/pharma-cmg-ehr-fhir-exp-test/v2/enrollment</a></td></tr></table><p><b>sender</b>: <a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-e69e5e73-0723-4f42-bfdd-b69f181160bf\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td>Vendor_AB</td><td><a href=\"http://vendor.com/fhir/enrollmentID/ENR-00001\">http://vendor.com/fhir/enrollmentID/ENR-00001</a></td></tr></table><p><b>focus</b>: <a href=\"Bundle-52d64634-22da-422b-81c0-9785c5e2bf15.html#urn-uuid-f4b96ed6-f050-4a39-b5ef-0138a8945fc3\">Bundle: identifier = Resource identifier: 2ca5fcf4-9296-4712-81bd-f26c5a930eee; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p></div>"
        },
        "eventCoding" : {
          "system" : "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type",
          "code" : "enrollment-only"
        },
        "destination" : [
          {
            "name" : "UAPI-ENR-V2.1",
            "endpoint" : "https://test-us-e1.apis.roche.com/pharma-cmg-ehr-fhir-exp-test/v2/enrollment"
          }
        ],
        "sender" : {
          "reference" : "urn:uuid:e69e5e73-0723-4f42-bfdd-b69f181160bf",
          "type" : "Organization"
        },
        "source" : {
          "name" : "Vendor_AB",
          "endpoint" : "http://vendor.com/fhir/enrollmentID/ENR-00001"
        },
        "focus" : [
          {
            "reference" : "urn:uuid:f4b96ed6-f050-4a39-b5ef-0138a8945fc3",
            "type" : "List"
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:f4b96ed6-f050-4a39-b5ef-0138a8945fc3",
      "resource" : {
        "resourceType" : "List",
        "id" : "f4b96ed6-f050-4a39-b5ef-0138a8945fc3",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"List_f4b96ed6-f050-4a39-b5ef-0138a8945fc3\"> </a><p class=\"res-header-id\"><b>Generated Narrative: List f4b96ed6-f050-4a39-b5ef-0138a8945fc3</b></p><a name=\"f4b96ed6-f050-4a39-b5ef-0138a8945fc3\"> </a><a name=\"hcf4b96ed6-f050-4a39-b5ef-0138a8945fc3\"> </a><h2>messageContext</h2><table class=\"clstu\"><tr><td>Mode: Change List </td><td>Status: Current </td></tr><tr><td/></tr></table><table class=\"grid\"><tr style=\"backgound-color: #eeeeee\"><td><b>Items</b></td></tr><tr><td><a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-1b315218-49b7-4264-816e-05d4b92ecbaa\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-e69e5e73-0723-4f42-bfdd-b69f181160bf\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-78ef1b71-b14a-44a1-a1e8-c9c9efcc157c\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-2722d5ae-1658-4d7f-8f64-de1299a1fb7f\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-0ec0f18c-5869-4d10-9752-79ea39e1f7ac\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-52d64634-22da-422b-81c0-9785c5e2bf15.html#urn-uuid-81c173aa-1afe-465b-8e93-2bcec59b98f2\">Bundle: identifier = Resource identifier: 2ca5fcf4-9296-4712-81bd-f26c5a930eee; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-52d64634-22da-422b-81c0-9785c5e2bf15.html#urn-uuid-cfda8005-9f32-4ddb-8f94-19da5beacc0d\">Bundle: identifier = Resource identifier: 2ca5fcf4-9296-4712-81bd-f26c5a930eee; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-4fd42cc9-559c-463e-8968-3e291ba91066.html#urn-uuid-94a59676-0e1f-42d6-b046-3c456758b90b\">Bundle: identifier = Resource identifier: 4fd42cc9-559c-463e-8968-3e291ba91066; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-4fd42cc9-559c-463e-8968-3e291ba91066.html#urn-uuid-b83bae44-3e47-4d5c-807e-41944016dc79\">Bundle: identifier = Resource identifier: 4fd42cc9-559c-463e-8968-3e291ba91066; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-e551b51b-0646-4b23-b1ac-9ec623756ec6\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-3f640e58-2f13-4d07-9356-8bc2ee64054d\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href=\"Bundle-52d64634-22da-422b-81c0-9785c5e2bf15.html#urn-uuid-6b5b6109-211b-4755-9a7f-9b5cb4fc836a\">Bundle: identifier = Resource identifier: 2ca5fcf4-9296-4712-81bd-f26c5a930eee; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr></table></div>"
        },
        "status" : "current",
        "mode" : "changes",
        "title" : "messageContext",
        "entry" : [
          {
            "item" : {
              "reference" : "urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa",
              "type" : "Patient"
            }
          },
          {
            "item" : {
              "reference" : "urn:uuid:e69e5e73-0723-4f42-bfdd-b69f181160bf",
              "type" : "Organization"
            }
          },
          {
            "item" : {
              "reference" : "urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c",
              "type" : "Practitioner"
            }
          },
          {
            "item" : {
              "reference" : "urn:uuid:2722d5ae-1658-4d7f-8f64-de1299a1fb7f",
              "type" : "Coverage"
            }
          },
          {
            "item" : {
              "reference" : "urn:uuid:0ec0f18c-5869-4d10-9752-79ea39e1f7ac",
              "type" : "RelatedPerson"
            }
          },
          {
            "item" : {
              "reference" : "urn:uuid:81c173aa-1afe-465b-8e93-2bcec59b98f2",
              "type" : "QuestionnaireResponse"
            }
          },
          {
            "item" : {
              "reference" : "urn:uuid:cfda8005-9f32-4ddb-8f94-19da5beacc0d",
              "type" : "Condition"
            }
          },
          {
            "item" : {
              "reference" : "urn:uuid:94a59676-0e1f-42d6-b046-3c456758b90b",
              "type" : "Consent"
            }
          },
          {
            "item" : {
              "reference" : "urn:uuid:b83bae44-3e47-4d5c-807e-41944016dc79",
              "type" : "Provenance"
            }
          },
          {
            "item" : {
              "reference" : "urn:uuid:e551b51b-0646-4b23-b1ac-9ec623756ec6",
              "type" : "Organization"
            }
          },
          {
            "item" : {
              "reference" : "urn:uuid:3f640e58-2f13-4d07-9356-8bc2ee64054d",
              "type" : "ServiceRequest"
            }
          },
          {
            "item" : {
              "reference" : "urn:uuid:6b5b6109-211b-4755-9a7f-9b5cb4fc836a",
              "type" : "MedicationRequest"
            }
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa",
      "resource" : {
        "resourceType" : "Patient",
        "id" : "1b315218-49b7-4264-816e-05d4b92ecbaa",
        "meta" : {
          "profile" : [
            🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-patient"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_1b315218-49b7-4264-816e-05d4b92ecbaa\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient 1b315218-49b7-4264-816e-05d4b92ecbaa</b></p><a name=\"1b315218-49b7-4264-816e-05d4b92ecbaa\"> </a><a name=\"hc1b315218-49b7-4264-816e-05d4b92ecbaa\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-patient.html\">UAPI Patient</a></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Ryan Michaelson (official) Male, DoB: 1972-10-29 ( Patient internal identifier: 6bcd8467-0473-4836-9128-2e7972f23177\u00a0(use:\u00a0official,\u00a0))</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\"><ul><li>ph: 1231231234(Home)</li><li>ph: 1234561234(Mobile)</li><li><a href=\"mailto:bobster83@example.com\">bobster83@example.com</a></li><li>1234 Main St San Francisco CA 94105 US </li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Language spoken\">Language:</td><td colspan=\"3\"><span title=\"Codes:{urn:ietf:bcp:47 en}\">English</span> (preferred)</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Patient Links\">Links:</td><td colspan=\"3\"><ul><li>General Practitioner: <a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-78ef1b71-b14a-44a1-a1e8-c9c9efcc157c\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></li><li>Managing Organization: <a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-e69e5e73-0723-4f42-bfdd-b69f181160bf\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></li></ul></td></tr></table></div>"
        },
        "identifier" : [
          {
            "use" : "official",
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code" : "PI",
                  "display" : "Patient internal identifier"
                }
              ]
            },
            "system" : "http://vendor.com/ab",
            "value" : "6bcd8467-0473-4836-9128-2e7972f23177",
            "assigner" : {
              "display" : "AB Vendor"
            }
          }
        ],
        "name" : [
          {
            "use" : "official",
            "family" : "Michaelson",
            "given" : [
              "Ryan"
            ]
          }
        ],
        "telecom" : [
          {
            "system" : "phone",
            "value" : "1231231234",
            "use" : "home",
            "rank" : 1
          },
          {
            "system" : "phone",
            "value" : "1234561234",
            "use" : "mobile",
            "rank" : 2
          },
          {
            "system" : "email",
            "value" : "bobster83@example.com",
            "use" : "home",
            "rank" : 3
          }
        ],
        "gender" : "male",
        "birthDate" : "1972-10-29",
        "address" : [
          {
            "line" : [
              "1234 Main St"
            ],
            "city" : "San Francisco",
            "state" : "CA",
            "postalCode" : "94105",
            "country" : "US"
          }
        ],
        "communication" : [
          {
            "language" : {
              "coding" : [
                {
                  "system" : "urn:ietf:bcp:47",
                  "code" : "en",
                  "display" : "English"
                }
              ]
            },
            "preferred" : true
          }
        ],
        "generalPractitioner" : [
          {
            "reference" : "urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c"
          }
        ],
        "managingOrganization" : {
          "reference" : "urn:uuid:e69e5e73-0723-4f42-bfdd-b69f181160bf"
        }
      }
    },
    {
      "fullUrl" : "urn:uuid:e69e5e73-0723-4f42-bfdd-b69f181160bf",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "e69e5e73-0723-4f42-bfdd-b69f181160bf",
        "meta" : {
          "profile" : [
            🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-organization"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_e69e5e73-0723-4f42-bfdd-b69f181160bf\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization e69e5e73-0723-4f42-bfdd-b69f181160bf</b></p><a name=\"e69e5e73-0723-4f42-bfdd-b69f181160bf\"> </a><a name=\"hce69e5e73-0723-4f42-bfdd-b69f181160bf\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-organization.html\">UAPI Organization</a></p></div><p><b>identifier</b>: <code>http://vendor.com/ab</code>/HOSP-12345\u00a0(use:\u00a0usual,\u00a0)</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: Mid Atlantic Retina</p><p><b>telecom</b>: <a href=\"mailto:mar@example.com\">mar@example.com</a></p><p><b>address</b>: 8 Ranoldo Terrace Cherry Hill NJ 08034 US </p><blockquote><p><b>contact</b></p><p><b>name</b>: Venus Yardav (Official)</p><p><b>telecom</b>: ph: 8882704882(Work), fax: 8179974042(Work)</p></blockquote></div>"
        },
        "identifier" : [
          {
            "use" : "usual",
            "system" : "http://vendor.com/ab",
            "value" : "HOSP-12345",
            "assigner" : {
              "display" : "AB Vendor"
            }
          }
        ],
        "type" : [
          {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
                "code" : "prov",
                "display" : "Healthcare Provider"
              }
            ]
          }
        ],
        "name" : "Mid Atlantic Retina",
        "telecom" : [
          {
            "system" : "email",
            "value" : "mar@example.com"
          }
        ],
        "address" : [
          {
            "line" : [
              "8 Ranoldo Terrace"
            ],
            "city" : "Cherry Hill",
            "state" : "NJ",
            "postalCode" : "08034",
            "country" : "US"
          }
        ],
        "contact" : [
          {
            "name" : {
              "use" : "official",
              "family" : "Yardav",
              "given" : [
                "Venus"
              ]
            },
            "telecom" : [
              {
                "system" : "phone",
                "value" : "8882704882",
                "use" : "work",
                "rank" : 1
              },
              {
                "system" : "fax",
                "value" : "8179974042",
                "use" : "work",
                "rank" : 2
              }
            ]
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c",
      "resource" : {
        "resourceType" : "Practitioner",
        "id" : "78ef1b71-b14a-44a1-a1e8-c9c9efcc157c",
        "meta" : {
          "profile" : [
            🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_78ef1b71-b14a-44a1-a1e8-c9c9efcc157c\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner 78ef1b71-b14a-44a1-a1e8-c9c9efcc157c</b></p><a name=\"78ef1b71-b14a-44a1-a1e8-c9c9efcc157c\"> </a><a name=\"hc78ef1b71-b14a-44a1-a1e8-c9c9efcc157c\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-practitioner.html\">UAPI Practitioner</a></p></div><p><b>identifier</b>: Provider number/1922071448\u00a0(use:\u00a0official,\u00a0), Tax ID number/00000000\u00a0(use:\u00a0official,\u00a0), National provider identifier/1639285034\u00a0(use:\u00a0official,\u00a0)</p><p><b>name</b>: MARISSA CRUZ (Official)</p></div>"
        },
        "identifier" : [
          {
            "use" : "official",
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code" : "PRN",
                  "display" : "Provider number"
                }
              ]
            },
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1922071448",
            "assigner" : {
              "display" : "Centers for Medicare & Medicaid Services"
            }
          },
          {
            "use" : "official",
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code" : "TAX",
                  "display" : "Tax ID number"
                }
              ]
            },
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "00000000"
          },
          {
            "use" : "official",
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code" : "NPI",
                  "display" : "National provider identifier"
                }
              ]
            },
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1639285034"
          }
        ],
        "name" : [
          {
            "use" : "official",
            "family" : "CRUZ",
            "given" : [
              "MARISSA"
            ]
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:2722d5ae-1658-4d7f-8f64-de1299a1fb7f",
      "resource" : {
        "resourceType" : "Coverage",
        "id" : "2722d5ae-1658-4d7f-8f64-de1299a1fb7f",
        "meta" : {
          "profile" : [
            🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_2722d5ae-1658-4d7f-8f64-de1299a1fb7f\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage 2722d5ae-1658-4d7f-8f64-de1299a1fb7f</b></p><a name=\"2722d5ae-1658-4d7f-8f64-de1299a1fb7f\"> </a><a name=\"hc2722d5ae-1658-4d7f-8f64-de1299a1fb7f\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-coverage.html\">UAPI Coverage</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span></p><p><b>subscriber</b>: <a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-0ec0f18c-5869-4d10-9752-79ea39e1f7ac\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>subscriberId</b>: 4353</p><p><b>beneficiary</b>: <a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-1b315218-49b7-4264-816e-05d4b92ecbaa\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>payor</b>: <a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-e551b51b-0646-4b23-b1ac-9ec623756ec6\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><h3>Classes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}\">Group</span></td><td>12344frgr</td><td>Group Number</td></tr></table><p><b>order</b>: 1</p><p><b>network</b>: Dakotacare</p></div>"
        },
        "status" : "active",
        "type" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code" : "HIP",
              "display" : "health insurance plan policy"
            }
          ]
        },
        "subscriber" : {
          "reference" : "urn:uuid:0ec0f18c-5869-4d10-9752-79ea39e1f7ac",
          "type" : "RelatedPerson"
        },
        "subscriberId" : "4353",
        "beneficiary" : {
          "reference" : "urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa",
          "type" : "Patient"
        },
        "payor" : [
          {
            "reference" : "urn:uuid:e551b51b-0646-4b23-b1ac-9ec623756ec6",
            "type" : "Organization"
          }
        ],
        "class" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                  "code" : "group",
                  "display" : "Group"
                }
              ]
            },
            "value" : "12344frgr",
            "name" : "Group Number"
          }
        ],
        "order" : 1,
        "network" : "Dakotacare"
      }
    },
    {
      "fullUrl" : "urn:uuid:0ec0f18c-5869-4d10-9752-79ea39e1f7ac",
      "resource" : {
        "resourceType" : "RelatedPerson",
        "id" : "0ec0f18c-5869-4d10-9752-79ea39e1f7ac",
        "meta" : {
          "profile" : [
            🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"RelatedPerson_0ec0f18c-5869-4d10-9752-79ea39e1f7ac\"> </a><p class=\"res-header-id\"><b>Generated Narrative: RelatedPerson 0ec0f18c-5869-4d10-9752-79ea39e1f7ac</b></p><a name=\"0ec0f18c-5869-4d10-9752-79ea39e1f7ac\"> </a><a name=\"hc0ec0f18c-5869-4d10-9752-79ea39e1f7ac\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-relatedPerson.html\">UAPI RelatedPerson</a></p></div><p><b>patient</b>: <a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-1b315218-49b7-4264-816e-05d4b92ecbaa\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode SIGOTHR}\">significant other</span></p><p><b>name</b>: Bob Paul Smith (Official)</p><p><b>telecom</b>: ph: 1234567890(Mobile)</p><p><b>birthDate</b>: 1972-10-29</p></div>"
        },
        "patient" : {
          "reference" : "urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa",
          "type" : "Patient"
        },
        "relationship" : [
          {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                "code" : "SIGOTHR",
                "display" : "significant other"
              }
            ]
          }
        ],
        "name" : [
          {
            "use" : "official",
            "family" : "Smith",
            "given" : [
              "Bob Paul"
            ]
          }
        ],
        "telecom" : [
          {
            "system" : "phone",
            "value" : "1234567890",
            "use" : "mobile"
          }
        ],
        "birthDate" : "1972-10-29"
      }
    },
    {
      "fullUrl" : "urn:uuid:81c173aa-1afe-465b-8e93-2bcec59b98f2",
      "resource" : {
        "resourceType" : "QuestionnaireResponse",
        "id" : "81c173aa-1afe-465b-8e93-2bcec59b98f2",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"QuestionnaireResponse_81c173aa-1afe-465b-8e93-2bcec59b98f2\"> </a><p class=\"res-header-id\"><b>Generated Narrative: QuestionnaireResponse 81c173aa-1afe-465b-8e93-2bcec59b98f2</b></p><a name=\"81c173aa-1afe-465b-8e93-2bcec59b98f2\"> </a><a name=\"hc81c173aa-1afe-465b-8e93-2bcec59b98f2\"> </a><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4B/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4B/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4B/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Definition</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4B/formats.html#table\" title=\"The type of the item\">Answer</a><span style=\"float: right\"><a href=\"https://hl7.org/fhir/R4B/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireResponseRoot\" class=\"hierarchy\"/> 81c173aa-1afe-465b-8e93-2bcec59b98f2</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Item\" class=\"hierarchy\"/> authorization</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Authorization #</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">23456789</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Item\" class=\"hierarchy\"/> preferred-sp-optional</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Preferred Specialty Pharmacy (Optional)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">SP pharmacy</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Item\" class=\"hierarchy\"/> contact-patient</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Do not contact patient</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Yes</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Item\" class=\"hierarchy\"/> pa-in-place</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Is prior authorization in place?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Yes</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Item\" class=\"hierarchy\"/> prescription-plan</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Is this a Prescription plan?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Yes</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Item\" class=\"hierarchy\"/> actemra-subcutaneous-weight-lbs</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Weight (lbs)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">111</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Item\" class=\"hierarchy\"/> sp-needed-for-rituxan-or-actemra</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Specialty Pharmacy Needed for RITUXAN or Actemra Dispensing?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">N/A</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Item\" class=\"hierarchy\"/> adot</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Anticipated Date of Treatment (Optional)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">2024-06-15</td></tr>\r\n<tr><td colspan=\"4\" class=\"hierarchy\"><br/><a href=\"https://hl7.org/fhir/R4B/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></div>"
        },
        "questionnaire" : "https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234",
        "status" : "completed",
        "subject" : {
          "reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c",
          "type" : "Patient"
        },
        "item" : [
          {
            "linkId" : "authorization",
            "text" : "Authorization #",
            "answer" : [
              {
                "valueString" : "23456789"
              }
            ]
          },
          {
            "linkId" : "preferred-sp-optional",
            "text" : "Preferred Specialty Pharmacy (Optional)",
            "answer" : [
              {
                "valueString" : "SP pharmacy"
              }
            ]
          },
          {
            "linkId" : "contact-patient",
            "text" : "Do not contact patient",
            "answer" : [
              {
                "valueString" : "Yes"
              }
            ]
          },
          {
            "linkId" : "pa-in-place",
            "text" : "Is prior authorization in place?",
            "answer" : [
              {
                "valueString" : "Yes"
              }
            ]
          },
          {
            "linkId" : "prescription-plan",
            "text" : "Is this a Prescription plan?",
            "answer" : [
              {
                "valueString" : "Yes"
              }
            ]
          },
          {
            "linkId" : "actemra-subcutaneous-weight-lbs",
            "text" : "Weight (lbs)",
            "answer" : [
              {
                "valueString" : "111"
              }
            ]
          },
          {
            "linkId" : "sp-needed-for-rituxan-or-actemra",
            "text" : "Specialty Pharmacy Needed for RITUXAN or Actemra Dispensing?",
            "answer" : [
              {
                "valueString" : "N/A"
              }
            ]
          },
          {
            "linkId" : "adot",
            "text" : "Anticipated Date of Treatment (Optional)",
            "answer" : [
              {
                "valueDate" : "2024-06-15"
              }
            ]
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:cfda8005-9f32-4ddb-8f94-19da5beacc0d",
      "resource" : {
        "resourceType" : "Condition",
        "id" : "cfda8005-9f32-4ddb-8f94-19da5beacc0d",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Condition_cfda8005-9f32-4ddb-8f94-19da5beacc0d\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Condition cfda8005-9f32-4ddb-8f94-19da5beacc0d</b></p><a name=\"cfda8005-9f32-4ddb-8f94-19da5beacc0d\"> </a><a name=\"hccfda8005-9f32-4ddb-8f94-19da5beacc0d\"> </a><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm M05.10}\">Rheumatoid lung disease w rheumatoid arthritis of unsp site</span></p><p><b>subject</b>: <a href=\"Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-fc2e5a72-c363-4616-ae00-4ad25cbcb45c\">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p></div>"
        },
        "code" : {
          "coding" : [
            {
              "system" : "http://hl7.org/fhir/sid/icd-10-cm",
              "code" : "M05.10"
            }
          ]
        },
        "subject" : {
          "reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c",
          "type" : "Patient"
        }
      }
    },
    {
      "fullUrl" : "urn:uuid:94a59676-0e1f-42d6-b046-3c456758b90b",
      "resource" : {
        "resourceType" : "Consent",
        "id" : "94a59676-0e1f-42d6-b046-3c456758b90b",
        "meta" : {
          "profile" : [
            🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-consent"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Consent_94a59676-0e1f-42d6-b046-3c456758b90b\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Consent 94a59676-0e1f-42d6-b046-3c456758b90b</b></p><a name=\"94a59676-0e1f-42d6-b046-3c456758b90b\"> </a><a name=\"hc94a59676-0e1f-42d6-b046-3c456758b90b\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-consent.html\">UAPI Consent</a></p></div><p><b>status</b>: Active</p><p><b>scope</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/consentscope patient-privacy}\">Privacy Consent</span></p><p><b>category</b>: <span title=\"Codes:{http://loinc.org 59284-0}\">Prescriber Signature</span></p><p><b>patient</b>: <a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-1b315218-49b7-4264-816e-05d4b92ecbaa\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>policyRule</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/consentpolicycodes hipaa-auth}\">HIPAA Authorization</span></p></div>"
        },
        "status" : "active",
        "scope" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/consentscope",
              "code" : "patient-privacy",
              "display" : "Privacy Consent"
            }
          ]
        },
        "category" : [
          {
            "coding" : [
              {
                "system" : "http://loinc.org",
                "code" : "59284-0",
                "display" : "Prescriber Signature"
              }
            ]
          }
        ],
        "patient" : {
          "reference" : "urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa",
          "type" : "Patient"
        },
        "policyRule" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/consentpolicycodes",
              "code" : "hipaa-auth",
              "display" : "HIPAA Authorization"
            }
          ]
        }
      }
    },
    {
      "fullUrl" : "urn:uuid:b83bae44-3e47-4d5c-807e-41944016dc79",
      "resource" : {
        "resourceType" : "Provenance",
        "id" : "b83bae44-3e47-4d5c-807e-41944016dc79",
        "meta" : {
          "profile" : [
            🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-provenance"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Provenance_b83bae44-3e47-4d5c-807e-41944016dc79\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Provenance b83bae44-3e47-4d5c-807e-41944016dc79</b></p><a name=\"b83bae44-3e47-4d5c-807e-41944016dc79\"> </a><a name=\"hcb83bae44-3e47-4d5c-807e-41944016dc79\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-provenance.html\">UAPI Provenance</a></p></div><p>Provenance for <a href=\"Bundle-4fd42cc9-559c-463e-8968-3e291ba91066.html#urn-uuid-94a59676-0e1f-42d6-b046-3c456758b90b\">Bundle: identifier = Resource identifier: 4fd42cc9-559c-463e-8968-3e291ba91066; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p>Summary</p><table class=\"grid\"><tr><td>Recorded</td><td>2022-02-07 09:49:39+0000</td></tr></table><p><b>Agents</b></p><table class=\"grid\"><tr><td><b>who</b></td></tr><tr><td><a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-78ef1b71-b14a-44a1-a1e8-c9c9efcc157c\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr></table></div>"
        },
        "target" : [
          {
            "reference" : "urn:uuid:94a59676-0e1f-42d6-b046-3c456758b90b",
            "type" : "Consent"
          }
        ],
        "recorded" : "2022-02-07T09:49:39.382941+00:00",
        "agent" : [
          {
            "who" : {
              "reference" : "urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c",
              "type" : "Practitioner"
            }
          }
        ],
        "signature" : [
          {
            "type" : [
              {
                "system" : "urn:iso-astm:E1762-95:2013",
                "code" : "1.2.840.10065.1.12.1.7",
                "display" : "Consent Signature"
              }
            ],
            "when" : "2022-02-07T09:49:39.382897+00:00",
            "who" : {
              "reference" : "urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c",
              "type" : "Practitioner"
            },
            "sigFormat" : "image/*",
            "data" : "bQ=="
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:3f640e58-2f13-4d07-9356-8bc2ee64054d",
      "resource" : {
        "resourceType" : "ServiceRequest",
        "id" : "3f640e58-2f13-4d07-9356-8bc2ee64054d",
        "meta" : {
          "profile" : [
            🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-servicerequest"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ServiceRequest_3f640e58-2f13-4d07-9356-8bc2ee64054d\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ServiceRequest 3f640e58-2f13-4d07-9356-8bc2ee64054d</b></p><a name=\"3f640e58-2f13-4d07-9356-8bc2ee64054d\"> </a><a name=\"hc3f640e58-2f13-4d07-9356-8bc2ee64054d\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-servicerequest.html\">UAPI ServiceRequest</a></p></div><p><b>status</b>: Active</p><p><b>intent</b>: Order</p><p><b>code</b>: <span title=\"Codes:{https://fhir.developer.gene.com/CodeSystem/uapi-sr-type bipa}\">Benefit Investigation / Prior Authorization</span></p><p><b>subject</b>: <a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-1b315218-49b7-4264-816e-05d4b92ecbaa\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p></div>"
        },
        "status" : "active",
        "intent" : "order",
        "code" : {
          "coding" : [
            {
              "system" : "https://fhir.developer.gene.com/CodeSystem/uapi-sr-type",
              "code" : "bipa"
            }
          ]
        },
        "subject" : {
          "reference" : "urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa",
          "type" : "Patient"
        }
      }
    },
    {
      "fullUrl" : "urn:uuid:6b5b6109-211b-4755-9a7f-9b5cb4fc836a",
      "resource" : {
        "resourceType" : "MedicationRequest",
        "id" : "6b5b6109-211b-4755-9a7f-9b5cb4fc836a",
        "meta" : {
          "profile" : [
            🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-medicationrequest"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MedicationRequest_6b5b6109-211b-4755-9a7f-9b5cb4fc836a\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MedicationRequest 6b5b6109-211b-4755-9a7f-9b5cb4fc836a</b></p><a name=\"6b5b6109-211b-4755-9a7f-9b5cb4fc836a\"> </a><a name=\"hc6b5b6109-211b-4755-9a7f-9b5cb4fc836a\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-medicationrequest.html\">UAPI MedicationRequest</a></p></div><p><b>status</b>: Active</p><p><b>intent</b>: Order</p><p><b>medication</b>: <span title=\"Codes:{https://fhir.developer.gene.com/CodeSystem/uapi-product-name actemraSubq}\">Actemra Subcutaneous</span></p><p><b>subject</b>: <a href=\"Bundle-13778a5c-73de-46e4-bb5a-3781a5c93b5e.html#urn-uuid-fc2e5a72-c363-4616-ae00-4ad25cbcb45c\">Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>requester</b>: <a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-78ef1b71-b14a-44a1-a1e8-c9c9efcc157c\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>insurance</b>: <a href=\"Bundle-05c47586-a4e8-4ab2-9dff-51f73ff6bda3.html#urn-uuid-2722d5ae-1658-4d7f-8f64-de1299a1fb7f\">Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p><p><b>note</b>: </p><blockquote><div><p>ACTPen 162mg</p>\n</div></blockquote><blockquote><p><b>dosageInstruction</b></p><p><b>timing</b>: Once per 2 weeks</p><h3>DoseAndRates</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Dose[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>162 mg</td></tr></table></blockquote><blockquote><p><b>dispenseRequest</b></p><p><b>numberOfRepeatsAllowed</b>: 12</p><h3>ExpectedSupplyDurations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Unit</b></td><td><b>System</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>mo</td><td><a href=\"http://terminology.hl7.org/6.4.0/CodeSystem-v3-ucum.html\">http://unitsofmeasure.org</a></td><td>mo</td></tr></table></blockquote></div>"
        },
        "status" : "active",
        "intent" : "order",
        "medicationCodeableConcept" : {
          "coding" : [
            {
              "system" : "https://fhir.developer.gene.com/CodeSystem/uapi-product-name",
              "code" : "actemraSubq",
              "display" : "Actemra Subcutaneous"
            }
          ]
        },
        "subject" : {
          "reference" : "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c",
          "type" : "Patient"
        },
        "requester" : {
          "reference" : "urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c",
          "type" : "Practitioner"
        },
        "insurance" : [
          {
            "reference" : "urn:uuid:2722d5ae-1658-4d7f-8f64-de1299a1fb7f",
            "type" : "Coverage"
          }
        ],
        "note" : [
          {
            "text" : "ACTPen 162mg"
          }
        ],
        "dosageInstruction" : [
          {
            "timing" : {
              "repeat" : {
                "frequency" : 1,
                "period" : 2,
                "periodUnit" : "wk"
              }
            },
            "doseAndRate" : [
              {
                "doseQuantity" : {
                  "value" : 162,
                  "unit" : "mg"
                }
              }
            ]
          }
        ],
        "dispenseRequest" : {
          "numberOfRepeatsAllowed" : 12,
          "expectedSupplyDuration" : {
            "value" : 1,
            "unit" : "mo",
            "system" : "http://unitsofmeasure.org",
            "code" : "mo"
          }
        }
      }
    },
    {
      "fullUrl" : "urn:uuid:e551b51b-0646-4b23-b1ac-9ec623756ec6",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "e551b51b-0646-4b23-b1ac-9ec623756ec6",
        "meta" : {
          "profile" : [
            🔗 "https://fhir.developer.gene.com/StructureDefinition/uapi-organization"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_e551b51b-0646-4b23-b1ac-9ec623756ec6\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization e551b51b-0646-4b23-b1ac-9ec623756ec6</b></p><a name=\"e551b51b-0646-4b23-b1ac-9ec623756ec6\"> </a><a name=\"hce551b51b-0646-4b23-b1ac-9ec623756ec6\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-organization.html\">UAPI Organization</a></p></div><p><b>identifier</b>: <code>http://vendor.com/ab</code>/PAY-111\u00a0(use:\u00a0usual,\u00a0)</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type ins}\">Insurance Company</span></p><p><b>name</b>: Dakotacare</p><p><b>telecom</b>: ph: 8778472862(Work)</p></div>"
        },
        "identifier" : [
          {
            "use" : "usual",
            "system" : "http://vendor.com/ab",
            "value" : "PAY-111",
            "assigner" : {
              "display" : "AB Vendor"
            }
          }
        ],
        "type" : [
          {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
                "code" : "ins"
              }
            ]
          }
        ],
        "name" : "Dakotacare",
        "telecom" : [
          {
            "system" : "phone",
            "value" : "8778472862",
            "use" : "work",
            "rank" : 1
          }
        ]
      }
    }
  ]
}