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: Cotellic
Profile: UAPI Bundle - AS Enrollment
Bundle ca5e6019-b4f7-41ae-a7f9-11903a8ab566 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:2758ea1a-0522-4190-9849-5e1719b1733d
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: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 Date of Treatment 2022-02-01 Onsite Pharmacy Name (Optional) Onsite Phcy Preferred Specialty Pharmacy (Optional) Pref Sp Phcy Do not contact patient Yes Has the patient been confirmed positive for BRAF V600E? Yes Has the patient been confirmed positive for BRAF V600K? 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 Is this a Prescription plan? No Re-verify benefits at PA expiration Yes Specialty Pharmacy? Yes TCPA Consent Provided? No Co-pay program Commercial Insurance Yes Metastatic Disease? No Disease stage 0-3? Yes 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: C43.0+C96.0
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:21b30e89-e799-484a-abcd-8c25c0b2599b
Resource Consent:
Profile: UAPI Consent
status: Active
category: Prescriber Signature
Entry 12 - fullUrl = urn:uuid:3cb05f30-9842-4651-a17d-930d7170bedf
Resource Provenance:
Profile: UAPI Provenance
Provenance for Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 08:10:13-0500
Summary
Recorded 2022-02-07 09:49:39+0000 Agents
who Bundle: identifier = Resource identifier: da5e1572-cc88-4e4d-9899-e3553f680d87; type = message; timestamp = 2020-03-11 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: Copay
Entry 15 - fullUrl = urn:uuid:2988979c-49e1-4a2e-a430-acbab6d525c8
Resource MedicationRequest:
Profile: UAPI MedicationRequest
status: Active
intent: Order
note:
60 mg Daily
dosageInstruction
text: 60 mg Daily for 21 days on, followed by 7-day rest period.
timing: Once per 1 day
DoseAndRates
Dose[x] 60 mg dispenseRequest
numberOfRepeatsAllowed: 12
ExpectedSupplyDurations
Value Unit System Code 3 mo http://unitsofmeasure.org mo
Entry 16 - 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)