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
<Bundle xmlns="http://hl7.org/fhir">
<id value="e5b43f05-70ca-4872-8a8f-9ac72439b7b1"/>
<meta>
<profile
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<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="RI"/>
<display value="Resource identifier"/>
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<system value="http://vendor.com/ab"/>
<value value="e5b43f05-70ca-4872-8a8f-9ac72439b7b1"/>
<assigner>
<display value="Alpha Beta"/>
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<type value="message"/>
<timestamp value="2020-03-11T08:10:13-05:00"/>
<entry>
<fullUrl value="urn:uuid:15ed158a-fbc5-4d29-a3b1-ff112ade7ac6"/>
<resource>
<MessageHeader>
<id value="15ed158a-fbc5-4d29-a3b1-ff112ade7ac6"/>
<meta>
<profile
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<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="MessageHeader_15ed158a-fbc5-4d29-a3b1-ff112ade7ac6"> </a><p class="res-header-id"><b>Generated Narrative: MessageHeader 15ed158a-fbc5-4d29-a3b1-ff112ade7ac6</b></p><a name="15ed158a-fbc5-4d29-a3b1-ff112ade7ac6"> </a><a name="hc15ed158a-fbc5-4d29-a3b1-ff112ade7ac6"> </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-with-consent: enrollment-with-consent</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-e5b43f05-70ca-4872-8a8f-9ac72439b7b1.html#urn-uuid-aac592fa-21de-4da2-bcfc-59bf0bae1a1e">Bundle: identifier = Resource identifier: e5b43f05-70ca-4872-8a8f-9ac72439b7b1; type = message; timestamp = 2020-03-11 08:10:13-0500</a></p></div>
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<eventCoding>
<system
value="http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type"/>
<code value="enrollment-with-consent"/>
</eventCoding>
<destination>
<name value="UAPI-ENR-V2.1"/>
<endpoint
value="https://test-us-e1.apis.roche.com/pharma-cmg-ehr-fhir-exp-test/v2/enrollment"/>
</destination>
<sender>
<reference value="urn:uuid:e69e5e73-0723-4f42-bfdd-b69f181160bf"/>
<type value="Organization"/>
</sender>
<source>
<name value="Vendor_AB"/>
<endpoint value="http://vendor.com/fhir/enrollmentID/ENR-00001"/>
</source>
<focus>
<reference value="urn:uuid:aac592fa-21de-4da2-bcfc-59bf0bae1a1e"/>
<type value="List"/>
</focus>
</MessageHeader>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:aac592fa-21de-4da2-bcfc-59bf0bae1a1e"/>
<resource>
<List>
<id value="aac592fa-21de-4da2-bcfc-59bf0bae1a1e"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="List_aac592fa-21de-4da2-bcfc-59bf0bae1a1e"> </a><p class="res-header-id"><b>Generated Narrative: List aac592fa-21de-4da2-bcfc-59bf0bae1a1e</b></p><a name="aac592fa-21de-4da2-bcfc-59bf0bae1a1e"> </a><a name="hcaac592fa-21de-4da2-bcfc-59bf0bae1a1e"> </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-e5b43f05-70ca-4872-8a8f-9ac72439b7b1.html#urn-uuid-555e9b57-6040-4d30-9aa4-8e8b42896c44">Bundle: identifier = Resource identifier: e5b43f05-70ca-4872-8a8f-9ac72439b7b1; type = message; timestamp = 2020-03-11 08:10:13-0500</a></td></tr><tr><td><a href="Bundle-e5b43f05-70ca-4872-8a8f-9ac72439b7b1.html#urn-uuid-f3adcde2-8cd1-433c-8434-5c993d077576">Bundle: identifier = Resource identifier: e5b43f05-70ca-4872-8a8f-9ac72439b7b1; 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-090e5caf-fdbd-4a67-8535-2983a3868f41">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-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-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-7ec5069e-799f-413a-a0d2-d107acdfad3d">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-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-4fd42cc9-559c-463e-8968-3e291ba91066.html#urn-uuid-970a569e-aeee-4c84-886d-f26c1e388214">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-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></table></div>
</text>
<status value="current"/>
<mode value="changes"/>
<title value="messageContext"/>
<entry>
<item>
<reference value="urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<type value="Patient"/>
</item>
</entry>
<entry>
<item>
<reference value="urn:uuid:e69e5e73-0723-4f42-bfdd-b69f181160bf"/>
<type value="Organization"/>
</item>
</entry>
<entry>
<item>
<reference value="urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c"/>
<type value="Practitioner"/>
</item>
</entry>
<entry>
<item>
<reference value="urn:uuid:555e9b57-6040-4d30-9aa4-8e8b42896c44"/>
<type value="MedicationRequest"/>
</item>
</entry>
<entry>
<item>
<reference value="urn:uuid:f3adcde2-8cd1-433c-8434-5c993d077576"/>
<type value="QuestionnaireResponse"/>
</item>
</entry>
<entry>
<item>
<reference value="urn:uuid:090e5caf-fdbd-4a67-8535-2983a3868f41"/>
<type value="Condition"/>
</item>
</entry>
<entry>
<item>
<reference value="urn:uuid:e551b51b-0646-4b23-b1ac-9ec623756ec6"/>
<type value="Organization"/>
</item>
</entry>
<entry>
<item>
<reference value="urn:uuid:2722d5ae-1658-4d7f-8f64-de1299a1fb7f"/>
<type value="Coverage"/>
</item>
</entry>
<entry>
<item>
<reference value="urn:uuid:7ec5069e-799f-413a-a0d2-d107acdfad3d"/>
<type value="Consent"/>
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</entry>
<entry>
<item>
<reference value="urn:uuid:94a59676-0e1f-42d6-b046-3c456758b90b"/>
<type value="Consent"/>
</item>
</entry>
<entry>
<item>
<reference value="urn:uuid:b83bae44-3e47-4d5c-807e-41944016dc79"/>
<type value="Provenance"/>
</item>
</entry>
<entry>
<item>
<reference value="urn:uuid:970a569e-aeee-4c84-886d-f26c1e388214"/>
<type value="ServiceRequest"/>
</item>
</entry>
<entry>
<item>
<reference value="urn:uuid:0ec0f18c-5869-4d10-9752-79ea39e1f7ac"/>
<type value="RelatedPerson"/>
</item>
</entry>
</List>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<resource>
<Patient>
<id value="1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-patient"/>
</meta>
<text>
<status value="generated"/>
<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 (use: official, ))</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>
</text>
<identifier>
<use value="official"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="PI"/>
<display value="Patient internal identifier"/>
</coding>
</type>
<system value="http://vendor.com/ab"/>
<value value="6bcd8467-0473-4836-9128-2e7972f23177"/>
<assigner>
<display value="AB Vendor"/>
</assigner>
</identifier>
<name>
<use value="official"/>
<family value="Michaelson"/>
<given value="Ryan"/>
</name>
<telecom>
<system value="phone"/>
<value value="1231231234"/>
<use value="home"/>
<rank value="1"/>
</telecom>
<telecom>
<system value="phone"/>
<value value="1234561234"/>
<use value="mobile"/>
<rank value="2"/>
</telecom>
<telecom>
<system value="email"/>
<value value="bobster83@example.com"/>
<use value="home"/>
<rank value="3"/>
</telecom>
<gender value="male"/>
<birthDate value="1972-10-29"/>
<address>
<line value="1234 Main St"/>
<city value="San Francisco"/>
<state value="CA"/>
<postalCode value="94105"/>
<country value="US"/>
</address>
<communication>
<language>
<coding>
<system value="urn:ietf:bcp:47"/>
<code value="en"/>
<display value="English"/>
</coding>
</language>
<preferred value="true"/>
</communication>
<generalPractitioner>
<reference value="urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c"/>
</generalPractitioner>
<managingOrganization>
<reference value="urn:uuid:e69e5e73-0723-4f42-bfdd-b69f181160bf"/>
</managingOrganization>
</Patient>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:e69e5e73-0723-4f42-bfdd-b69f181160bf"/>
<resource>
<Organization>
<id value="e69e5e73-0723-4f42-bfdd-b69f181160bf"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-organization"/>
</meta>
<text>
<status value="generated"/>
<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 (use: usual, )</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>
</text>
<identifier>
<use value="usual"/>
<system value="http://vendor.com/ab"/>
<value value="HOSP-12345"/>
<assigner>
<display value="AB Vendor"/>
</assigner>
</identifier>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/organization-type"/>
<code value="prov"/>
<display value="Healthcare Provider"/>
</coding>
</type>
<name value="Mid Atlantic Retina"/>
<telecom>
<system value="email"/>
<value value="mar@example.com"/>
</telecom>
<address>
<line value="8 Ranoldo Terrace"/>
<city value="Cherry Hill"/>
<state value="NJ"/>
<postalCode value="08034"/>
<country value="US"/>
</address>
<contact>
<name>
<use value="official"/>
<family value="Yardav"/>
<given value="Venus"/>
</name>
<telecom>
<system value="phone"/>
<value value="8882704882"/>
<use value="work"/>
<rank value="1"/>
</telecom>
<telecom>
<system value="fax"/>
<value value="8179974042"/>
<use value="work"/>
<rank value="2"/>
</telecom>
</contact>
</Organization>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c"/>
<resource>
<Practitioner>
<id value="78ef1b71-b14a-44a1-a1e8-c9c9efcc157c"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner"/>
</meta>
<text>
<status value="generated"/>
<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 (use: official, ), Tax ID number/00000000 (use: official, ), National provider identifier/1639285034 (use: official, )</p><p><b>name</b>: MARISSA CRUZ (Official)</p></div>
</text>
<identifier>
<use value="official"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="PRN"/>
<display value="Provider number"/>
</coding>
</type>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="1922071448"/>
<assigner>
<display value="Centers for Medicare & Medicaid Services"/>
</assigner>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="TAX"/>
<display value="Tax ID number"/>
</coding>
</type>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="00000000"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="NPI"/>
<display value="National provider identifier"/>
</coding>
</type>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="1639285034"/>
</identifier>
<name>
<use value="official"/>
<family value="CRUZ"/>
<given value="MARISSA"/>
</name>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:2722d5ae-1658-4d7f-8f64-de1299a1fb7f"/>
<resource>
<Coverage>
<id value="2722d5ae-1658-4d7f-8f64-de1299a1fb7f"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-coverage"/>
</meta>
<text>
<status value="generated"/>
<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>
</text>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="HIP"/>
<display value="health insurance plan policy"/>
</coding>
</type>
<subscriber>
<reference value="urn:uuid:0ec0f18c-5869-4d10-9752-79ea39e1f7ac"/>
<type value="RelatedPerson"/>
</subscriber>
<subscriberId value="4353"/>
<beneficiary>
<reference value="urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<type value="Patient"/>
</beneficiary>
<payor>
<reference value="urn:uuid:e551b51b-0646-4b23-b1ac-9ec623756ec6"/>
<type value="Organization"/>
</payor>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="group"/>
<display value="Group"/>
</coding>
</type>
<value value="12344frgr"/>
<name value="Group Number"/>
</class>
<order value="1"/>
<network value="Dakotacare"/>
</Coverage>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:0ec0f18c-5869-4d10-9752-79ea39e1f7ac"/>
<resource>
<RelatedPerson>
<id value="0ec0f18c-5869-4d10-9752-79ea39e1f7ac"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson"/>
</meta>
<text>
<status value="generated"/>
<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>
</text>
<patient>
<reference value="urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<type value="Patient"/>
</patient>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="SIGOTHR"/>
<display value="significant other"/>
</coding>
</relationship>
<name>
<use value="official"/>
<family value="Smith"/>
<given value="Bob Paul"/>
</name>
<telecom>
<system value="phone"/>
<value value="1234567890"/>
<use value="mobile"/>
</telecom>
<birthDate value="1972-10-29"/>
</RelatedPerson>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:090e5caf-fdbd-4a67-8535-2983a3868f41"/>
<resource>
<Condition>
<id value="090e5caf-fdbd-4a67-8535-2983a3868f41"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Condition_090e5caf-fdbd-4a67-8535-2983a3868f41"> </a><p class="res-header-id"><b>Generated Narrative: Condition 090e5caf-fdbd-4a67-8535-2983a3868f41</b></p><a name="090e5caf-fdbd-4a67-8535-2983a3868f41"> </a><a name="hc090e5caf-fdbd-4a67-8535-2983a3868f41"> </a><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/sid/icd-10-cm C50.011}">Malignant neoplasm of nipple and areola, right female breast</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>
</text>
<code>
<coding>
<system value="http://hl7.org/fhir/sid/icd-10-cm"/>
<code value="C50.011"/>
</coding>
</code>
<subject>
<reference value="urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<type value="Patient"/>
</subject>
</Condition>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:7ec5069e-799f-413a-a0d2-d107acdfad3d"/>
<resource>
<Consent>
<id value="7ec5069e-799f-413a-a0d2-d107acdfad3d"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-consent"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Consent_7ec5069e-799f-413a-a0d2-d107acdfad3d"> </a><p class="res-header-id"><b>Generated Narrative: Consent 7ec5069e-799f-413a-a0d2-d107acdfad3d</b></p><a name="7ec5069e-799f-413a-a0d2-d107acdfad3d"> </a><a name="hc7ec5069e-799f-413a-a0d2-d107acdfad3d"> </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}">Patient Authorization 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>dateTime</b>: 2016-06-16 16:24:45+0000</p><p><b>performer</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><h3>Provisions</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td></tr><tr><td style="display: none">*</td><td>Opt In</td></tr></table></div>
</text>
<status value="active"/>
<scope>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/consentscope"/>
<code value="patient-privacy"/>
<display value="Privacy Consent"/>
</coding>
</scope>
<category>
<coding>
<system value="http://loinc.org"/>
<code value="59284-0"/>
<display value="Patient Authorization Signature"/>
</coding>
</category>
<patient>
<reference value="urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<type value="Patient"/>
</patient>
<dateTime value="2016-06-16T16:24:45Z"/>
<performer>
<reference value="urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<type value="Patient"/>
</performer>
<policyRule>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/consentpolicycodes"/>
<code value="hipaa-auth"/>
<display value="HIPAA Authorization"/>
</coding>
</policyRule>
<provision>
<type value="permit"/>
</provision>
</Consent>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:94a59676-0e1f-42d6-b046-3c456758b90b"/>
<resource>
<Consent>
<id value="94a59676-0e1f-42d6-b046-3c456758b90b"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-consent"/>
</meta>
<text>
<status value="generated"/>
<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>
</text>
<status value="active"/>
<scope>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/consentscope"/>
<code value="patient-privacy"/>
<display value="Privacy Consent"/>
</coding>
</scope>
<category>
<coding>
<system value="http://loinc.org"/>
<code value="59284-0"/>
<display value="Prescriber Signature"/>
</coding>
</category>
<patient>
<reference value="urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<type value="Patient"/>
</patient>
<policyRule>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/consentpolicycodes"/>
<code value="hipaa-auth"/>
<display value="HIPAA Authorization"/>
</coding>
</policyRule>
</Consent>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:b83bae44-3e47-4d5c-807e-41944016dc79"/>
<resource>
<Provenance>
<id value="b83bae44-3e47-4d5c-807e-41944016dc79"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-provenance"/>
</meta>
<text>
<status value="generated"/>
<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>
</text>
<target>
<reference value="urn:uuid:94a59676-0e1f-42d6-b046-3c456758b90b"/>
<type value="Consent"/>
</target>
<recorded value="2022-02-07T09:49:39.382941+00:00"/>
<agent>
<who>
<reference value="urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c"/>
<type value="Practitioner"/>
</who>
</agent>
<signature>
<type>
<system value="urn:iso-astm:E1762-95:2013"/>
<code value="1.2.840.10065.1.12.1.7"/>
<display value="Consent Signature"/>
</type>
<when value="2022-02-07T09:49:39.382897+00:00"/>
<who>
<reference value="urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c"/>
<type value="Practitioner"/>
</who>
<sigFormat value="image/*"/>
<data value="bQ=="/>
</signature>
</Provenance>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:970a569e-aeee-4c84-886d-f26c1e388214"/>
<resource>
<ServiceRequest>
<id value="970a569e-aeee-4c84-886d-f26c1e388214"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-servicerequest"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="ServiceRequest_970a569e-aeee-4c84-886d-f26c1e388214"> </a><p class="res-header-id"><b>Generated Narrative: ServiceRequest 970a569e-aeee-4c84-886d-f26c1e388214</b></p><a name="970a569e-aeee-4c84-886d-f26c1e388214"> </a><a name="hc970a569e-aeee-4c84-886d-f26c1e388214"> </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 gpf}">Patient Foundation</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>
</text>
<status value="active"/>
<intent value="order"/>
<code>
<coding>
<system
value="https://fhir.developer.gene.com/CodeSystem/uapi-sr-type"/>
<code value="gpf"/>
</coding>
</code>
<subject>
<reference value="urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<type value="Patient"/>
</subject>
</ServiceRequest>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:555e9b57-6040-4d30-9aa4-8e8b42896c44"/>
<resource>
<MedicationRequest>
<id value="555e9b57-6040-4d30-9aa4-8e8b42896c44"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-medicationrequest"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="MedicationRequest_555e9b57-6040-4d30-9aa4-8e8b42896c44"> </a><p class="res-header-id"><b>Generated Narrative: MedicationRequest 555e9b57-6040-4d30-9aa4-8e8b42896c44</b></p><a name="555e9b57-6040-4d30-9aa4-8e8b42896c44"> </a><a name="hc555e9b57-6040-4d30-9aa4-8e8b42896c44"> </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 itovebi}">Itovebi</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><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>9 mg once daily</p>
</div></blockquote><blockquote><p><b>dosageInstruction</b></p><p><b>text</b>: 9 mg once daily for 3 months</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>9 mg</td></tr></table></blockquote><blockquote><p><b>dispenseRequest</b></p><p><b>numberOfRepeatsAllowed</b>: 2</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>
</text>
<status value="active"/>
<intent value="order"/>
<medicationCodeableConcept>
<coding>
<system
value="https://fhir.developer.gene.com/CodeSystem/uapi-product-name"/>
<code value="itovebi"/>
<display value="Itovebi"/>
</coding>
</medicationCodeableConcept>
<subject>
<reference value="urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<type value="Patient"/>
</subject>
<requester>
<reference value="urn:uuid:78ef1b71-b14a-44a1-a1e8-c9c9efcc157c"/>
<type value="Practitioner"/>
</requester>
<insurance>
<reference value="urn:uuid:2722d5ae-1658-4d7f-8f64-de1299a1fb7f"/>
<type value="Coverage"/>
</insurance>
<note>
<text value="9 mg once daily"/>
</note>
<dosageInstruction>
<text value="9 mg once daily for 3 months"/>
<doseAndRate>
<doseQuantity>
<value value="9"/>
<unit value="mg"/>
</doseQuantity>
</doseAndRate>
</dosageInstruction>
<dispenseRequest>
<numberOfRepeatsAllowed value="2"/>
<expectedSupplyDuration>
<value value="1"/>
<unit value="mo"/>
<system value="http://unitsofmeasure.org"/>
<code value="mo"/>
</expectedSupplyDuration>
</dispenseRequest>
</MedicationRequest>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:e551b51b-0646-4b23-b1ac-9ec623756ec6"/>
<resource>
<Organization>
<id value="e551b51b-0646-4b23-b1ac-9ec623756ec6"/>
<meta>
<profile
value="https://fhir.developer.gene.com/StructureDefinition/uapi-organization"/>
</meta>
<text>
<status value="generated"/>
<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 (use: usual, )</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>
</text>
<identifier>
<use value="usual"/>
<system value="http://vendor.com/ab"/>
<value value="PAY-111"/>
<assigner>
<display value="AB Vendor"/>
</assigner>
</identifier>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/organization-type"/>
<code value="ins"/>
</coding>
</type>
<name value="Dakotacare"/>
<telecom>
<system value="phone"/>
<value value="8778472862"/>
<use value="work"/>
<rank value="1"/>
</telecom>
</Organization>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:f3adcde2-8cd1-433c-8434-5c993d077576"/>
<resource>
<QuestionnaireResponse>
<id value="f3adcde2-8cd1-433c-8434-5c993d077576"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="QuestionnaireResponse_f3adcde2-8cd1-433c-8434-5c993d077576"> </a><p class="res-header-id"><b>Generated Narrative: QuestionnaireResponse f3adcde2-8cd1-433c-8434-5c993d077576</b></p><a name="f3adcde2-8cd1-433c-8434-5c993d077576"> </a><a name="hcf3adcde2-8cd1-433c-8434-5c993d077576"> </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,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAABmJLR0QA/wD/AP+gvaeTAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB3RJTUUH3goXBCwdPqAP0wAAAldJREFUOMuNk0tIlFEYhp9z/vE2jHkhxXA0zJCMitrUQlq4lnSltEqCFhFG2MJFhIvIFpkEWaTQqjaWZRkp0g26URZkTpbaaOJkDqk10szoODP//7XIMUe0elcfnPd9zsfLOYplGrpRwZaqTtw3K7PtGem7Q6FoidbGgqHVy/HRb669R+56zx7eRV1L31JGxYbBtjKK93cxeqfyQHbehkZbUkK20goELEuIzEd+dHS+qz/Y8PTSif0FnGkbiwcAjHaU1+QWOptFiyCLp/LnKptpqIuXHx6rbR26kJcBX3yLgBfnd7CxwJmflpP2wUg0HIAoUUpZBmKzELGWcN8nAr6Gpu7tLU/CkwAaoKTWRSQyt89Q8w6J+oVQkKnBoblH7V0PPvUOvDYXfopE/SJmALsxnVm6LbkotrUtNowMeIrVrBcBpaMmdS0j9df7abpSuy7HWehwJdt1lhVwi/J58U5beXGAF6c3UXLycw1wdFklArBn87xdh0ZsZtArghBdAA3+OEDVubG4UEzP6x1FOWneHh2VDAHBAt80IbdXDcesNoCvs3E5AFyNSU5nbrDPZpcUEQQTFZiEVx+51fxMhhyJEAgvlriadIJZZksRuwBYMOPBbO3hePVVqgEJhFeUuFLhIPkRP6BQLIBrmMenujm/3g4zc398awIe90Zb5A1vREALqneMcYgP/xVQWlG+Ncu5vgwwlaUNx+3799rfe96u9K0JSDXcOzOTJg4B6IgmXfsygc7/Bvg9g9E58/cDVmGIBOP/zT8Bz1zqWqpbXIsd0O9hajXfL6u4BaOS6SeWAAAAAElFTkSuQmCC" 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"/> f3adcde2-8cd1-433c-8434-5c993d077576</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>
<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">No</td></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_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"/> ins-type-1</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">Insurance Type 1</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">Comm</td></tr>
<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"/> ship-to</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">Ship To</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">Patient</td></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_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"/> shipment-options</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">Shipment Options</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">Upfront</td></tr>
<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"/> itovebi-other-medicines-prescribed</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">Other Medicines Prescribed</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">None</td></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_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"/> itovebi-drug-allergies</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">Drug Allergies</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">No Known</td></tr>
<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"/> tcpa-consent</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">TCPA Consent Provided?</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">No</td></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_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"/> household-size</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">Household size (including you)</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">4</td></tr>
<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"/> household-income-amount</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">Annual household income amount </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">$75000</td></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_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"/> contact-patient</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">Do not contact patient</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">No</td></tr>
<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"/> has-treatment-started</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">Has treatment started?</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>
<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"/> eligibility-reason</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">Eligibility Reason</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">Insured: Can't afford Medication</td></tr>
<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_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: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> detailed-message</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">Ok to leave detailed message</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">No</td></tr>
<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>
</text>
<questionnaire
value="https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/1234"/>
<status value="completed"/>
<subject>
<reference value="urn:uuid:1b315218-49b7-4264-816e-05d4b92ecbaa"/>
<type value="Patient"/>
</subject>
<item>
<linkId value="prescription-plan"/>
<text value="Is this a Prescription plan?"/>
<answer>
<valueString value="No"/>
</answer>
</item>
<item>
<linkId value="ins-type-1"/>
<text value="Insurance Type 1"/>
<answer>
<valueString value="Comm"/>
</answer>
</item>
<item>
<linkId value="ship-to"/>
<text value="Ship To"/>
<answer>
<valueString value="Patient"/>
</answer>
</item>
<item>
<linkId value="shipment-options"/>
<text value="Shipment Options"/>
<answer>
<valueString value="Upfront"/>
</answer>
</item>
<item>
<linkId value="itovebi-other-medicines-prescribed"/>
<text value="Other Medicines Prescribed"/>
<answer>
<valueString value="None"/>
</answer>
</item>
<item>
<linkId value="itovebi-drug-allergies"/>
<text value="Drug Allergies"/>
<answer>
<valueString value="No Known"/>
</answer>
</item>
<item>
<linkId value="tcpa-consent"/>
<text value="TCPA Consent Provided?"/>
<answer>
<valueString value="No"/>
</answer>
</item>
<item>
<linkId value="household-size"/>
<text value="Household size (including you)"/>
<answer>
<valueString value="4"/>
</answer>
</item>
<item>
<linkId value="household-income-amount"/>
<text value="Annual household income amount "/>
<answer>
<valueString value="$75000"/>
</answer>
</item>
<item>
<linkId value="contact-patient"/>
<text value="Do not contact patient"/>
<answer>
<valueString value="No"/>
</answer>
</item>
<item>
<linkId value="has-treatment-started"/>
<text value="Has treatment started?"/>
<answer>
<valueString value="Yes"/>
</answer>
</item>
<item>
<linkId value="eligibility-reason"/>
<text value="Eligibility Reason"/>
<answer>
<valueString value="Insured: Can't afford Medication"/>
</answer>
</item>
<item>
<linkId value="detailed-message"/>
<text value="Ok to leave detailed message"/>
<answer>
<valueString value="No"/>
</answer>
</item>
</QuestionnaireResponse>
</resource>
</entry>
</Bundle>