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: Venclexta
Profile: UAPI Bundle - AS Enrollment
Bundle df929183-0365-4f13-b558-0c455b47e544 of type message
Entry 1 - fullUrl = urn:uuid:67379338-7852-425e-aa9b-f68d03699943
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:34768fee-4578-46fc-b51e-540e9685d65f
Resource List:
messageContext
Mode: Change List Status: Current
Entry 3 - fullUrl = urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa
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: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500
- Managing Organization: Bundle: identifier = Resource identifier: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500
Entry 4 - fullUrl = urn:uuid:e69e5e73-0723-4f42-bfdd-b69f181160bf
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:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c
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:2722d5ae-1658-4d7f-8f64-de1299a1fb7f
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:0ec0f18c-5869-4d10-9752-79ea39e1f7ac
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:090e5caf-fdbd-4a67-8535-2983a3868f41
Resource Condition:
code: Chronic lymphocytic leuk of B-cell type not achieve remis
Entry 9 - fullUrl = urn:uuid:7ec5069e-799f-413a-a0d2-d107acdfad3d
Resource Consent:
Profile: UAPI Consent
status: Active
category: Patient Authorization Signature
provision
Entry 10 - fullUrl = urn:uuid:b83bae44-3e47-4d5c-807e-41944016dc79
Resource Provenance:
Profile: UAPI Provenance
Provenance for Bundle: identifier = Resource identifier: 4fd42cc9-559c-463e-8968-3e291ba91066; 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: 05c47586-a4e8-4ab2-9dff-51f73ff6bda3; type = message; timestamp = 2020-03-11 08:10:13-0500
Entry 11 - fullUrl = urn:uuid:94a59676-0e1f-42d6-b046-3c456758b90b
Resource Consent:
Profile: UAPI Consent
status: Active
category: Prescriber Signature
Entry 12 - fullUrl = urn:uuid:3f640e58-2f13-4d07-9356-8bc2ee64054d
Resource ServiceRequest:
Profile: UAPI ServiceRequest
status: Active
intent: Order
code: Benefit Investigation / Prior Authorization
Entry 13 - fullUrl = urn:uuid:ccd28c58-83e7-4657-b06a-53c8cc4ac94f
Resource ServiceRequest:
Profile: UAPI ServiceRequest
status: Active
intent: Order
code: Copay
Entry 14 - fullUrl = urn:uuid:28d3f8af-7f77-43ed-9d84-ed67eaa2e674
Resource MedicationRequest:
Profile: UAPI MedicationRequest
status: Active
intent: Order
courseOfTherapyType: CLL/SLL (Maint)
note:
Maintenance
dosageInstruction
timing: Once per 1 day
DoseAndRates
Dose[x] 200 mg dispenseRequest
numberOfRepeatsAllowed: 1
ExpectedSupplyDurations
Value Unit System Code 1 mo http://unitsofmeasure.org mo
Entry 15 - fullUrl = urn:uuid:e551b51b-0646-4b23-b1ac-9ec623756ec6
Resource Organization:
Profile: UAPI Organization
identifier:
http://vendor.com/ab/PAY-111 (use: usual, )type: Insurance Company
name: Dakotacare
Contacts
Telecom ph: 8778472862(Work)
Entry 16 - fullUrl = urn:uuid:694ce192-7b69-4d75-8f91-0031bb2b0811
Resource QuestionnaireResponse:
LinkID Text Definition Answer 694ce192-7b69-4d75-8f91-0031bb2b0811
Questionnaire:https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234 authorization
Authorization # #3456789 Date of Treatment 2022-02-28 Onsite Pharmacy Name (Optional) OSP - name Pharmacy Contact Person (Optional) Ph contact Pharmacy Phone (Optional) 222-222-2222 Preferred Specialty Pharmacy (Optional) PSP Name Do not contact patient No Ok to leave a detailed message? Yes Has treatment started? Yes Line of therapy? First Onsite Pharmacy? Yes Is prior authorization in place? Yes Is this a Prescription plan? No Re-verify benefits at PA expiration No Specialty Pharmacy? Yes TCPA Consent Provided? Yes Co-pay program Commercial Insurance No Documentation for this format
