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: Tecentriq
Profile: UAPI Bundle - AS Enrollment
Bundle 9f296966-298f-40c4-93d1-ac4789cd33d5 of type message
Entry 1 - fullUrl = urn:uuid:eb5eb40b-78e8-4a52-903a-0348c1eac387
Resource MessageHeader:
Profile: UAPI MessageHeader
event: uapi-event-type enrollment-with-consent: enrollment-with-consent
Destinations
Name UAPI-ENR-V2.1 Sources
Name Vendor_AB
Entry 2 - fullUrl = urn:uuid:2dd2061f-9dc2-4b00-9275-24c550fbf825
Resource List:
messageContext
Mode: Change List Status: Current
Entry 3 - fullUrl = urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c
Resource Patient:
Profile: UAPI Patient
Ryan Michaelson (official) Male, DoB: 1972-10-29 ( Patient internal identifier: 6bcd8467-0473-4836-9128-2e7972f23177 (use: official, ))
Contact Detail
- ph: 1231231234(Home)
- ph: 1234561234(Mobile)
- bobster83@example.com
- 1234 Main St San Francisco CA 94105 US
Language: English (preferred) Links:
- General Practitioner: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
- Managing Organization: Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Entry 4 - fullUrl = urn:uuid:01c31a2f-321d-4c6e-8349-206af8a88088
Resource Organization:
Profile: UAPI Organization
identifier:
http://vendor.com/ab/HOSP-12345 (use: usual, )type: Healthcare Provider
name: Mid Atlantic Retina
contact
telecom: mar@example.com
address: 8 Ranoldo Terrace Cherry Hill NJ 08034 US
contact
name: Venus Yardav (Official)
telecom: ph: 8882704882(Work), fax: 8179974042(Work)
Entry 5 - fullUrl = urn:uuid:695d0991-5e03-46df-934a-85a28acd95c1
Resource Practitioner:
Profile: UAPI Practitioner
identifier: Provider number/1922071448 (use: official, ), Tax ID number/00000000 (use: official, ), National provider identifier/1639285034 (use: official, )
name: MARISSA CRUZ (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:4db51d32-65c3-4f8c-959e-0155c6d14545
Resource RelatedPerson:
Profile: UAPI RelatedPerson
relationship: significant other
name: Bob Paul Smith (Official)
telecom: ph: 1234567890(Mobile)
birthDate: 1972-10-29
Entry 8 - fullUrl = urn:uuid:cab05dba-d4fd-4fd9-b8f4-f82f87a7ce83
Resource QuestionnaireResponse:
LinkID Text Definition Answer cab05dba-d4fd-4fd9-b8f4-f82f87a7ce83
Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234 authorization
Authorization # 123456789 Date of Treatment 2022-02-02 Onsite Pharmacy Name (Optional) Onsite Phcy Preferred Specialty Pharmacy (Optional) Pref SP Do not contact patient No Ok to leave a detailed message? Yes Has treatment started? Yes Line of therapy? Second Onsite Pharmacy? Yes Is prior authorization in place? Yes Place of Service Infusion Center Is this a Prescription plan? Yes Re-verify benefits at PA expiration No Site of Treatment Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500 Specialty Pharmacy? Yes TCPA Consent Provided? Yes Adjuvant Therapy Treatment? Yes PD-L1 positive? Yes Metastatic Disease? Yes Co-pay program Commercial Insurance No Was the patient a clinical trial participant for this medicine? Yes Documentation for this format
Entry 9 - fullUrl = urn:uuid:bc20c5ea-f639-4221-ab61-ce75c5e64aba
Resource Condition:
code: Malignant neoplasm of trachea
Entry 10 - fullUrl = urn:uuid:1b53bfb2-1361-4906-acd8-35294d30273b
Resource Consent:
Profile: UAPI Consent
status: Active
category: Patient Authorization Signature
provision
Entry 11 - fullUrl = urn:uuid:45cf0b29-8c1d-4882-91e1-00bc28c06a52
Resource Organization:
Profile: UAPI Organization
identifier:
http://SOT.com/ab/Infusion Site Id (use: usual, )type: Site of Treatment
name: Infusion Centre
contact
telecom: ph: 8882704882(Work), fax: 8179974042(Work)
address: 8 Ranoldo Terrace Cherry Hill NJ 08034 US
contact
name: Venus Yardav (Official)
telecom: ph: -unknown-
Entry 12 - fullUrl = urn:uuid:212c57ad-45cd-4882-87e7-8415ded3db05
Resource ServiceRequest:
Profile: UAPI ServiceRequest
status: Active
intent: Order
code: Benefit Investigation / Prior Authorization
Entry 13 - fullUrl = urn:uuid:f71a66c4-f747-4b46-8adc-875a45f8ee7e
Resource ServiceRequest:
Profile: UAPI ServiceRequest
status: Active
intent: Order
code: Copay
Entry 14 - fullUrl = urn:uuid:27fb7151-7399-47d8-90c8-5c42eb5e2648
Resource MedicationRequest:
Profile: UAPI MedicationRequest
status: Active
intent: Order
Entry 15 - fullUrl = urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f
Resource Organization:
Profile: UAPI Organization
identifier:
http://vendor.com/ab/PAY-111 (use: usual, )type: Insurance Company
name: Dakotacare
Contacts
Telecom ph: 8778472862(Work)