Universal API Implementation Guide
1.1.19 - ci-build
Universal API Implementation Guide - Local Development build (v1.1.19). See the Directory of published versions
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:Bundle;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "7c8f5054-015b-4bce-99f5-4160a82a4225"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-copay-enrollment-bundle";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-copay-enrollment-bundle> ]
];
fhir:Bundle.identifier [
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ];
fhir:Coding.code [ fhir:value "RI" ];
fhir:Coding.display [ fhir:value "Resource identifier" ] ] ];
fhir:Identifier.system [ fhir:value "http://vendor.com/ab" ];
fhir:Identifier.value [ fhir:value "7c8f5054-015b-4bce-99f5-4160a82a4225" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "Alpha Beta" ] ]
];
fhir:Bundle.type [ fhir:value "message"];
fhir:Bundle.timestamp [ fhir:value "2020-03-11T08:10:13-05:00"^^xsd:dateTime];
fhir:Bundle.entry [
fhir:index 0;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:05621068-0e0b-4bc3-a0d0-d21f9270bcfd" ];
fhir:Bundle.entry.resource <urn:uuid:05621068-0e0b-4bc3-a0d0-d21f9270bcfd>
], [
fhir:index 1;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0" ];
fhir:Bundle.entry.resource <urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0>
], [
fhir:index 2;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c" ];
fhir:Bundle.entry.resource <urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c>
], [
fhir:index 3;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2" ];
fhir:Bundle.entry.resource <urn:uuid:be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2>
], [
fhir:index 4;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f" ];
fhir:Bundle.entry.resource <urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f>
], [
fhir:index 5;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:982e97af-668d-41ef-b9f9-2bbc4a059330" ];
fhir:Bundle.entry.resource <urn:uuid:982e97af-668d-41ef-b9f9-2bbc4a059330>
], [
fhir:index 6;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:cc31cf51-ea4f-4623-bdbb-2ea9e0068a20" ];
fhir:Bundle.entry.resource <urn:uuid:cc31cf51-ea4f-4623-bdbb-2ea9e0068a20>
], [
fhir:index 7;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:984b9cae-45b0-407a-a682-11213a40a12f" ];
fhir:Bundle.entry.resource <urn:uuid:984b9cae-45b0-407a-a682-11213a40a12f>
], [
fhir:index 8;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:42b41bdb-1781-49aa-a091-78cdd92129df" ];
fhir:Bundle.entry.resource <urn:uuid:42b41bdb-1781-49aa-a091-78cdd92129df>
], [
fhir:index 9;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:d212ac11-903c-4040-a3d7-6b3e1874a311" ];
fhir:Bundle.entry.resource <urn:uuid:d212ac11-903c-4040-a3d7-6b3e1874a311>
], [
fhir:index 10;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:226e6ff9-9b26-4d4e-8e5e-e100770d6f4d" ];
fhir:Bundle.entry.resource <urn:uuid:226e6ff9-9b26-4d4e-8e5e-e100770d6f4d>
], [
fhir:index 11;
fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:12ed44e8-fde2-415d-9dcc-8e9117c73d2a" ];
fhir:Bundle.entry.resource <urn:uuid:12ed44e8-fde2-415d-9dcc-8e9117c73d2a>
].
<urn:uuid:05621068-0e0b-4bc3-a0d0-d21f9270bcfd> a fhir:MessageHeader;
fhir:Resource.id [ fhir:value "05621068-0e0b-4bc3-a0d0-d21f9270bcfd"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-messageheader> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "extensions" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: MessageHeader</b><a name=\"05621068-0e0b-4bc3-a0d0-d21f9270bcfd\"> </a></p><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\">Resource MessageHeader \"05621068-0e0b-4bc3-a0d0-d21f9270bcfd\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-messageheader.html\">UAPI MessageHeader</a></p></div><p><b>UAPI MessageHeader Timestamp</b>: 2020-03-11 08:10:13-0500</p><p><b>event</b>: copay-enrollment (Details: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type code copay-enrollment = 'copay-enrollment', stated as 'null')</p><h3>Destinations</h3><table class=\"grid\"><tr><td>-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td>*</td><td>UAPI-COPAY-ENR-V1.0</td><td><a href=\"https://test-us-e1.apis.roche.com/pharma-cmg-copay-exp-test/v1/enroll\">https://test-us-e1.apis.roche.com/pharma-cmg-copay-exp-test/v1/enroll</a></td></tr></table><p><b>sender</b>: <a href=\"#Organization_be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2\">See above (urn:uuid:be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2)</a></p><h3>Sources</h3><table class=\"grid\"><tr><td>-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td>*</td><td>Vendor_Tailormed</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=\"#List_8e055260-dd74-4c89-9ccf-3d2f47135ee0\">See above (urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0)</a></p></div>"
];
fhir:DomainResource.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/message-timestamp" ];
fhir:Extension.valueDateTime [ fhir:value "2020-03-11T08:10:13-05:00"^^xsd:dateTime ]
];
fhir:MessageHeader.eventCoding [
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-event-type" ];
fhir:Coding.code [ fhir:value "copay-enrollment" ]
];
fhir:MessageHeader.destination [
fhir:index 0;
fhir:MessageHeader.destination.name [ fhir:value "UAPI-COPAY-ENR-V1.0" ];
fhir:MessageHeader.destination.endpoint [ fhir:value "https://test-us-e1.apis.roche.com/pharma-cmg-copay-exp-test/v1/enroll" ]
];
fhir:MessageHeader.sender [
fhir:Reference.reference [ fhir:value "urn:uuid:be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2" ];
fhir:Reference.type [ fhir:value "Organization" ]
];
fhir:MessageHeader.source [
fhir:MessageHeader.source.name [ fhir:value "Vendor_Tailormed" ];
fhir:MessageHeader.source.endpoint [ fhir:value "http://vendor.com/fhir/enrollmentID/ENR-00001" ]
];
fhir:MessageHeader.focus [
fhir:index 0;
fhir:Reference.reference [ fhir:value "urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0" ];
fhir:Reference.type [ fhir:value "List" ]
].
<urn:uuid:8e055260-dd74-4c89-9ccf-3d2f47135ee0> a fhir:List;
fhir:Resource.id [ fhir:value "8e055260-dd74-4c89-9ccf-3d2f47135ee0"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: List</b><a name=\"8e055260-dd74-4c89-9ccf-3d2f47135ee0\"> </a></p><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\">Resource List \"8e055260-dd74-4c89-9ccf-3d2f47135ee0\" </p></div><p><b>status</b>: current</p><p><b>mode</b>: changes</p><p><b>title</b>: messageContext</p><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#Patient_fc2e5a72-c363-4616-ae00-4ad25cbcb45c\">See above (urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c)</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#Organization_be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2\">See above (urn:uuid:be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2)</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#Organization_d3637025-883d-4678-9e0a-1d243a338f9f\">See above (urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f)</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#Organization_982e97af-668d-41ef-b9f9-2bbc4a059330\">See above (urn:uuid:982e97af-668d-41ef-b9f9-2bbc4a059330)</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#Practitioner_cc31cf51-ea4f-4623-bdbb-2ea9e0068a20\">See above (urn:uuid:cc31cf51-ea4f-4623-bdbb-2ea9e0068a20)</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"Bundle-88b42c3d-2926-46de-b696-e8713f02f8cb.html#urn-uuid-c29782b4-6ffc-494e-85ab-eee27bfd994a\">urn:uuid:c29782b4-6ffc-494e-85ab-eee27bfd994a</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#Coverage_42b41bdb-1781-49aa-a091-78cdd92129df\">See above (urn:uuid:42b41bdb-1781-49aa-a091-78cdd92129df)</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#Coverage_d212ac11-903c-4040-a3d7-6b3e1874a311\">See above (urn:uuid:d212ac11-903c-4040-a3d7-6b3e1874a311)</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"Bundle-88b42c3d-2926-46de-b696-e8713f02f8cb.html#urn-uuid-72d8daf1-f80f-4e56-bfcb-0558caf74feb\">urn:uuid:72d8daf1-f80f-4e56-bfcb-0558caf74feb</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>item</b>: <a href=\"#RelatedPerson_12ed44e8-fde2-415d-9dcc-8e9117c73d2a\">See above (urn:uuid:12ed44e8-fde2-415d-9dcc-8e9117c73d2a)</a></p></blockquote></div>"
];
fhir:List.status [ fhir:value "current"];
fhir:List.mode [ fhir:value "changes"];
fhir:List.title [ fhir:value "messageContext"];
fhir:List.entry [
fhir:index 0;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c" ];
fhir:Reference.type [ fhir:value "Patient" ] ]
], [
fhir:index 1;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2" ];
fhir:Reference.type [ fhir:value "Organization" ] ]
], [
fhir:index 2;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f" ];
fhir:Reference.type [ fhir:value "Organization" ] ]
], [
fhir:index 3;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:982e97af-668d-41ef-b9f9-2bbc4a059330" ];
fhir:Reference.type [ fhir:value "Organization" ] ]
], [
fhir:index 4;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:cc31cf51-ea4f-4623-bdbb-2ea9e0068a20" ];
fhir:Reference.type [ fhir:value "Practitioner" ] ]
], [
fhir:index 5;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:c29782b4-6ffc-494e-85ab-eee27bfd994a" ];
fhir:Reference.type [ fhir:value "QuestionnaireResponse" ] ]
], [
fhir:index 6;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:42b41bdb-1781-49aa-a091-78cdd92129df" ];
fhir:Reference.type [ fhir:value "Coverage" ] ]
], [
fhir:index 7;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:d212ac11-903c-4040-a3d7-6b3e1874a311" ];
fhir:Reference.type [ fhir:value "Coverage" ] ]
], [
fhir:index 8;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:72d8daf1-f80f-4e56-bfcb-0558caf74feb" ];
fhir:Reference.type [ fhir:value "Task" ] ]
], [
fhir:index 9;
fhir:List.entry.item [
fhir:Reference.reference [ fhir:value "urn:uuid:12ed44e8-fde2-415d-9dcc-8e9117c73d2a" ];
fhir:Reference.type [ fhir:value "RelatedPerson" ] ]
].
<urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c> a fhir:Patient;
fhir:Resource.id [ fhir:value "fc2e5a72-c363-4616-ae00-4ad25cbcb45c"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-patient";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-patient> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Patient</b><a name=\"fc2e5a72-c363-4616-ae00-4ad25cbcb45c\"> </a></p><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\">Resource Patient \"fc2e5a72-c363-4616-ae00-4ad25cbcb45c\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-patient.html\">UAPI Patient</a></p></div><p><b>identifier</b>: Patient internal identifier: 6bcd8467-0473-4836-9128-2e7972f23177(use: USUAL)</p><p><b>name</b>: Ryan Michaelson (OFFICIAL)</p><p><b>telecom</b>: ph: 1231231234(HOME), ph: 1234561234(MOBILE), <a href=\"mailto:bobster83@example.com\">bobster83@example.com</a></p><p><b>gender</b>: male</p><p><b>birthDate</b>: 1972-10-29</p><p><b>address</b>: 1234 Main St San Francisco CA 94105 US </p><h3>Communications</h3><table class=\"grid\"><tr><td>-</td><td><b>Language</b></td><td><b>Preferred</b></td></tr><tr><td>*</td><td>English <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v3-ietf3066.html\">Tags for the Identification of Languages</a>#en)</span></td><td>true</td></tr></table><p><b>generalPractitioner</b>: <a href=\"#Practitioner_cc31cf51-ea4f-4623-bdbb-2ea9e0068a20\">See above (urn:uuid:cc31cf51-ea4f-4623-bdbb-2ea9e0068a20)</a></p><p><b>managingOrganization</b>: <a href=\"#Organization_be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2\">See above (urn:uuid:be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2)</a></p></div>"
];
fhir:Patient.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "usual" ];
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ];
fhir:Coding.code [ fhir:value "PI" ];
fhir:Coding.display [ fhir:value "Patient internal identifier" ] ] ];
fhir:Identifier.system [ fhir:value "http://vendor.com/ab" ];
fhir:Identifier.value [ fhir:value "6bcd8467-0473-4836-9128-2e7972f23177" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "AB Vendor" ] ]
];
fhir:Patient.name [
fhir:index 0;
fhir:HumanName.use [ fhir:value "official" ];
fhir:HumanName.family [ fhir:value "Michaelson" ];
fhir:HumanName.given [
fhir:value "Ryan";
fhir:index 0 ]
];
fhir:Patient.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "1231231234" ];
fhir:ContactPoint.use [ fhir:value "home" ];
fhir:ContactPoint.rank [ fhir:value "1"^^xsd:positiveInteger ]
], [
fhir:index 1;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "1234561234" ];
fhir:ContactPoint.use [ fhir:value "mobile" ];
fhir:ContactPoint.rank [ fhir:value "2"^^xsd:positiveInteger ]
], [
fhir:index 2;
fhir:ContactPoint.system [ fhir:value "email" ];
fhir:ContactPoint.value [ fhir:value "bobster83@example.com" ];
fhir:ContactPoint.use [ fhir:value "home" ];
fhir:ContactPoint.rank [ fhir:value "3"^^xsd:positiveInteger ]
];
fhir:Patient.gender [ fhir:value "male"];
fhir:Patient.birthDate [ fhir:value "1972-10-29"^^xsd:date];
fhir:Patient.address [
fhir:index 0;
fhir:Address.line [
fhir:value "1234 Main St";
fhir:index 0 ];
fhir:Address.city [ fhir:value "San Francisco" ];
fhir:Address.state [ fhir:value "CA" ];
fhir:Address.postalCode [ fhir:value "94105" ];
fhir:Address.country [ fhir:value "US" ]
];
fhir:Patient.communication [
fhir:index 0;
fhir:Patient.communication.language [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "urn:ietf:bcp:47" ];
fhir:Coding.code [ fhir:value "en" ];
fhir:Coding.display [ fhir:value "English" ] ] ];
fhir:Patient.communication.preferred [ fhir:value "true"^^xsd:boolean ]
];
fhir:Patient.generalPractitioner [
fhir:index 0;
fhir:Reference.reference [ fhir:value "urn:uuid:cc31cf51-ea4f-4623-bdbb-2ea9e0068a20" ]
];
fhir:Patient.managingOrganization [
fhir:Reference.reference [ fhir:value "urn:uuid:be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2" ]
].
<urn:uuid:be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2> a fhir:Organization;
fhir:Resource.id [ fhir:value "be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-organization";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-organization> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2\"> </a></p><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\">Resource Organization \"be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-organization.html\">UAPI Organization</a></p></div><p><b>identifier</b>: id: HOSP-12345(use: USUAL), National provider identifier: 1922071448(use: USUAL)</p><p><b>type</b>: Healthcare Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4B/codesystem-organization-type.html\">OrganizationType</a>#prov)</span></p><p><b>name</b>: Cleveland Clinic</p><p><b>telecom</b>: ph: 8882704882(WORK)</p><p><b>address</b>: 8 Ranoldo Terrace Cherry Hill NJ 08034 US </p><h3>Contacts</h3><table class=\"grid\"><tr><td>-</td><td><b>Name</b></td><td><b>Telecom</b></td></tr><tr><td>*</td><td>MARISSA CRUZ (OFFICIAL)</td><td>ph: -unknown-</td></tr></table></div>"
];
fhir:Organization.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "usual" ];
fhir:Identifier.system [ fhir:value "http://vendor.com/ab" ];
fhir:Identifier.value [ fhir:value "HOSP-12345" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "AB Vendor" ] ]
], [
fhir:index 1;
fhir:Identifier.use [ fhir:value "usual" ];
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ];
fhir:Coding.code [ fhir:value "NPI" ];
fhir:Coding.display [ fhir:value "National provider identifier" ] ] ];
fhir:Identifier.system [ fhir:value "http://hl7.org/fhir/sid/us-npi" ];
fhir:Identifier.value [ fhir:value "1922071448" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "Cleveland Clinic" ] ]
];
fhir:Organization.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/organization-type" ];
fhir:Coding.code [ fhir:value "prov" ];
fhir:Coding.display [ fhir:value "Healthcare Provider" ] ]
];
fhir:Organization.name [ fhir:value "Cleveland Clinic"];
fhir:Organization.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "8882704882" ];
fhir:ContactPoint.use [ fhir:value "work" ];
fhir:ContactPoint.rank [ fhir:value "1"^^xsd:positiveInteger ]
];
fhir:Organization.address [
fhir:index 0;
fhir:Address.line [
fhir:value "8 Ranoldo Terrace";
fhir:index 0 ];
fhir:Address.city [ fhir:value "Cherry Hill" ];
fhir:Address.state [ fhir:value "NJ" ];
fhir:Address.postalCode [ fhir:value "08034" ];
fhir:Address.country [ fhir:value "US" ]
];
fhir:Organization.contact [
fhir:index 0;
fhir:Organization.contact.name [
fhir:HumanName.use [ fhir:value "official" ];
fhir:HumanName.family [ fhir:value "CRUZ" ];
fhir:HumanName.given [
fhir:value "MARISSA";
fhir:index 0 ] ];
fhir:Organization.contact.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ] ]
].
<urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f> a fhir:Organization;
fhir:Resource.id [ fhir:value "d3637025-883d-4678-9e0a-1d243a338f9f"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-organization";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-organization> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"d3637025-883d-4678-9e0a-1d243a338f9f\"> </a></p><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\">Resource Organization \"d3637025-883d-4678-9e0a-1d243a338f9f\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-organization.html\">UAPI Organization</a></p></div><p><b>identifier</b>: id: PAY-111(use: USUAL)</p><p><b>type</b>: Insurance Company <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4B/codesystem-organization-type.html\">OrganizationType</a>#ins)</span></p><p><b>name</b>: Kaiser</p><p><b>telecom</b>: ph: 8778472862(WORK)</p></div>"
];
fhir:Organization.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "usual" ];
fhir:Identifier.system [ fhir:value "http://vendor.com/ab" ];
fhir:Identifier.value [ fhir:value "PAY-111" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "AB Vendor" ] ]
];
fhir:Organization.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/organization-type" ];
fhir:Coding.code [ fhir:value "ins" ] ]
];
fhir:Organization.name [ fhir:value "Kaiser"];
fhir:Organization.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "8778472862" ];
fhir:ContactPoint.use [ fhir:value "work" ];
fhir:ContactPoint.rank [ fhir:value "1"^^xsd:positiveInteger ]
].
<urn:uuid:982e97af-668d-41ef-b9f9-2bbc4a059330> a fhir:Organization;
fhir:Resource.id [ fhir:value "982e97af-668d-41ef-b9f9-2bbc4a059330"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-organization";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-organization> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"982e97af-668d-41ef-b9f9-2bbc4a059330\"> </a></p><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\">Resource Organization \"982e97af-668d-41ef-b9f9-2bbc4a059330\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-organization.html\">UAPI Organization</a></p></div><p><b>identifier</b>: id: PAY-145(use: USUAL)</p><p><b>type</b>: Insurance Company <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4B/codesystem-organization-type.html\">OrganizationType</a>#ins)</span></p><p><b>name</b>: CVS Specialty</p><p><b>telecom</b>: ph: -unknown-</p><h3>Contacts</h3><table class=\"grid\"><tr><td>-</td><td><b>Telecom</b></td></tr><tr><td>*</td><td>ph: 8778472862(WORK)</td></tr></table></div>"
];
fhir:Organization.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "usual" ];
fhir:Identifier.system [ fhir:value "http://vendor.com/ab" ];
fhir:Identifier.value [ fhir:value "PAY-145" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "Ph Vendor" ] ]
];
fhir:Organization.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/organization-type" ];
fhir:Coding.code [ fhir:value "ins" ] ]
];
fhir:Organization.name [ fhir:value "CVS Specialty"];
fhir:Organization.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ]
];
fhir:Organization.contact [
fhir:index 0;
fhir:Organization.contact.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "8778472862" ];
fhir:ContactPoint.use [ fhir:value "work" ];
fhir:ContactPoint.rank [ fhir:value "1"^^xsd:positiveInteger ] ]
].
<urn:uuid:cc31cf51-ea4f-4623-bdbb-2ea9e0068a20> a fhir:Practitioner;
fhir:Resource.id [ fhir:value "cc31cf51-ea4f-4623-bdbb-2ea9e0068a20"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-practitioner> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "extensions" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Practitioner</b><a name=\"cc31cf51-ea4f-4623-bdbb-2ea9e0068a20\"> </a></p><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\">Resource Practitioner \"cc31cf51-ea4f-4623-bdbb-2ea9e0068a20\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-practitioner.html\">UAPI Practitioner</a></p></div><p><b>UAPI Practitioner Preferred Contact Method</b>: work-phone <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-prescriber-contact-method.html\">UAPI Code System - Prescriber Contact Methods</a>#work-phone)</span></p><p><b>UAPI Practitioner Shipment Method</b>: morning <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-prescriber-contact-time.html\">UAPI Code System - Prescriber Contact Times</a>#morning)</span></p><p><b>identifier</b>: Provider identifier: 1922071448(use: OFFICIAL), National provider identifier: 1639285034(use: OFFICIAL)</p><p><b>name</b>: MARISSA ANNE CRUZ (OFFICIAL)</p><p><b>telecom</b>: ph: 8882704882(WORK), fax: 8882704883(WORK), <a href=\"mailto:prescribercopay@example.com\">prescribercopay@example.com</a></p><p><b>address</b>: 8 Ranoldo Terrace Cherry Hill NJ 08034 US </p><h3>Qualifications</h3><table class=\"grid\"><tr><td>-</td><td><b>Code</b></td></tr><tr><td>*</td><td>Doctor of Medicine <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v2-0360.html\">degreeLicenseCertificate</a>#MD)</span></td></tr></table></div>"
];
fhir:DomainResource.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-preferred-contact-method" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://fhir.developer.gene.com/CodeSystem/prescriber-contact-method" ];
fhir:Coding.code [ fhir:value "work-phone" ] ] ]
], [
fhir:index 1;
fhir:Extension.url [ fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-preferred-contact-time" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://fhir.developer.gene.com/CodeSystem/prescriber-contact-time" ];
fhir:Coding.code [ fhir:value "morning" ] ] ]
];
fhir:Practitioner.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "official" ];
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ];
fhir:Coding.code [ fhir:value "PRN" ];
fhir:Coding.display [ fhir:value "Provider identifier" ] ] ];
fhir:Identifier.system [ fhir:value "http://hl7.org/fhir/sid/us-npi" ];
fhir:Identifier.value [ fhir:value "1922071448" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "Cleveland Clinic" ] ]
], [
fhir:index 1;
fhir:Identifier.use [ fhir:value "official" ];
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ];
fhir:Coding.code [ fhir:value "NPI" ];
fhir:Coding.display [ fhir:value "National provider identifier" ] ] ];
fhir:Identifier.system [ fhir:value "http://hl7.org/fhir/sid/us-npi" ];
fhir:Identifier.value [ fhir:value "1639285034" ]
];
fhir:Practitioner.name [
fhir:index 0;
fhir:HumanName.use [ fhir:value "official" ];
fhir:HumanName.family [ fhir:value "CRUZ" ];
fhir:HumanName.given [
fhir:value "MARISSA";
fhir:index 0 ], [
fhir:value "ANNE";
fhir:index 1 ];
fhir:HumanName.prefix [
fhir:value "Dr";
fhir:index 0 ];
fhir:HumanName.suffix [
fhir:value "Junior";
fhir:index 0 ]
];
fhir:Practitioner.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "8882704882" ];
fhir:ContactPoint.use [ fhir:value "work" ];
fhir:ContactPoint.rank [ fhir:value "1"^^xsd:positiveInteger ]
], [
fhir:index 1;
fhir:ContactPoint.system [ fhir:value "fax" ];
fhir:ContactPoint.value [ fhir:value "8882704883" ];
fhir:ContactPoint.use [ fhir:value "work" ];
fhir:ContactPoint.rank [ fhir:value "2"^^xsd:positiveInteger ]
], [
fhir:index 2;
fhir:ContactPoint.system [ fhir:value "email" ];
fhir:ContactPoint.value [ fhir:value "prescribercopay@example.com" ];
fhir:ContactPoint.use [ fhir:value "work" ];
fhir:ContactPoint.rank [ fhir:value "3"^^xsd:positiveInteger ]
];
fhir:Practitioner.address [
fhir:index 0;
fhir:Address.line [
fhir:value "8 Ranoldo Terrace";
fhir:index 0 ];
fhir:Address.city [ fhir:value "Cherry Hill" ];
fhir:Address.state [ fhir:value "NJ" ];
fhir:Address.postalCode [ fhir:value "08034" ];
fhir:Address.country [ fhir:value "US" ]
];
fhir:Practitioner.qualification [
fhir:index 0;
fhir:Practitioner.qualification.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0360" ];
fhir:Coding.code [ fhir:value "MD" ] ] ]
].
<urn:uuid:984b9cae-45b0-407a-a682-11213a40a12f> a fhir:QuestionnaireResponse;
fhir:Resource.id [ fhir:value "984b9cae-45b0-407a-a682-11213a40a12f"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: QuestionnaireResponse</b><a name=\"984b9cae-45b0-407a-a682-11213a40a12f\"> </a></p><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\">Resource QuestionnaireResponse \"984b9cae-45b0-407a-a682-11213a40a12f\" </p></div><p><b>questionnaire</b>: <a href=\"https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/4321\">https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/4321</a></p><p><b>status</b>: completed</p><p><b>subject</b>: <a href=\"#Patient_fc2e5a72-c363-4616-ae00-4ad25cbcb45c\">See above (urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c)</a></p><blockquote><p><b>item</b></p><p><b>linkId</b>: consent-to-enroll</p><p><b>text</b>: Does the patient consent to enroll in the Genentech Oncology Co-Pay Program?</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Yes</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: polivy-fda-approved-indications</p><p><b>text</b>: Is the patient using POLIVY™ (polatuzumab vedotin-piiq) for one of the following FDA-approved indications?</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>POLIVY is a prescription medicine used with other medicines, bendamustine and a rituximab product, to treat diffuse large B-cell lymphoma in adults who have had at least 2 prior therapies.\nThe conditional approval of POLIVY is based on a type of response rate. There are ongoing studies to establish how well the drug works. (Details: [not stated] code combination = 'combination', stated as 'POLIVY is a prescription medicine used with other medicines, bendamustine and a rituximab product, to treat diffuse large B-cell lymphoma in adults who have had at least 2 prior therapies.\nThe conditional approval of POLIVY is based on a type of response rate. There are ongoing studies to establish how well the drug works.')</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 18-years-or-older</p><p><b>text</b>: Is the patient 18 years of age or older</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Yes</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: commercial-private-insurance</p><p><b>text</b>: Is the patient on commercial (also known as private) insurance? This includes insurance from an employer and non-government funded insurance purchased from a health insurance marketplace</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Yes</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: federal-state-funded-insurance</p><p><b>text</b>: Is the patient using any federal or state-funded health care program? This includes, but is not limited to, Medicare, Medicaid, Medigap, VA, DoD and TRICARE.</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>No</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: have-medicare-card</p><p><b>text</b>: Does the patient have a Medicare (red, white and blue) card?</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>No</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: residence-state</p><p><b>text</b>: What state does the patient live in?</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>DC</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: receiving-medication-from-gpf</p><p><b>text</b>: Is the patient currently receiving Polivy from the Genentech Patient Foundation?</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>No</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: receiving-assistance-from-charitable-organization</p><p><b>text</b>: Is the patient currently receiving assistance from any other charitable organization for any of their out-of-pocket costs that are covered by the Genentech Oncology Co-pay Program?</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>No</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: agree-to-genentech-privacy-policy</p><p><b>text</b>: The patient acknowledges and agrees that any patient information disclosed during the enrollment, including contact information, demographic information, and information related to their medical condition, treatments, and health insurance and benefits, will be shared with Genentech, the sponsor of the program, its partners, and their respective affiliates. In addition, information shared by the pharmacy/physician, such as the date the prescription was filled, the date the medication was administered by the physician (if applicable) and the amount that will be reimbursed by Genentech will also be shared. The patient authorizes Genentech to receive, use, and share patient personal information in connection with the Genentech Oncology Co-pay Program. The patient agrees to be contacted by phone, mail or email about the Genentech Oncology Co-pay Program. You have notified the patient that they can find more information in the Genentech Privacy Policy at www.gene.com/privacy-policy.</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Agree</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: agree-to-copay-program-terms</p><p><b>text</b>: The Co-pay Program is valid ONLY for patients with commercial (private or non-governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medicine. Patients using Medicare, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD), TRICARE or any other federal or state government program (collectively, “Government Programs”) to pay for their Genentech medicine are not eligible. The Program is not valid for Genentech medicines that are eligible to be reimbursed in their entirety by private insurance plans or other programs.\n\nUnder the Program, the patient may pay a co-pay. The final amount owed by a patient may be as little as $0 for the Genentech medicine (see Program specific details). The total patient out-of-pocket cost is dependent on the patient’s health insurance plan. The Program assists with the cost of the Genentech medicine only. It does not assist with the cost of other medicines, procedures or office visit fees. After reaching the maximum annual Program benefit amount, the patient will be responsible for all remaining out-of-pocket expenses. The Program benefit amount cannot exceed the patient’s out-of-pocket expenses for the cost associated with the Genentech medicine. The maximum Program benefit will reset every January 1st. The Program is not health insurance or a benefit plan. The patient’s non-governmental insurance is the primary payer. The Program does not obligate the use of any specific medicine or provider. Patients receiving assistance from charitable free medicine programs (such as the Genentech Patient Foundation) or any other charitable organizations for the same expenses covered by the Program are not eligible. The Program benefit cannot be combined with any other rebate, free trial or a similar offer for the Genentech medicine. No party may seek reimbursement for all or any part of the benefit received through the Program.\n\nThe Program may be accepted by participating pharmacies, physicians’ offices or hospitals. Once a patient is enrolled, the Program will honor claims with a date of service that precedes the Program enrollment date up to 180 days. Claims must be submitted within 365 days from the date of service unless otherwise indicated. Use of the Program must be consistent with all relevant health insurance requirements. Participating patients, pharmacies, physicians’ offices and hospitals are responsible for reporting the receipt of all Program benefits as required by any insurer or by law. Programs’ benefits may not be sold, purchased, traded or offered for sale.\n\nThe patient or their guardian must be 18 years of age or older to receive Program assistance. The Program is only valid in the United States and U.S. Territories, is void where prohibited by law and shall follow state restrictions in relation to AB-rated generic equivalents (e.g., MA, CA) where applicable. Eligible patients will be automatically re-enrolled in the Program on an annual basis. Eligible patients will be removed from the Program after 3 years of inactivity (e.g., no claims submitted in a 3-year timeframe). Program eligibility and automatic re-enrollment are contingent upon the patient’s ability to meet all requirements set forth by the Program. Healthcare providers may not advertise or otherwise use the Program as a means of promoting their services or Genentech medicines to patients. The Program is intended for the patient. Only the patient using the Program may receive the funds made available through the Program. The Program is not intended for third parties who reduce the amount available to the patient or take a portion for their own purposes. Patients with health plans that redirect Genentech Program assistance intended for patient out-of-pocket costs may be subject to alternate Program benefit structures. Genentech reserves the right to rescind, revoke or amend the Program without notice at any time.</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Agree</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: polivy-combo-with-rituxan</p><p><b>text</b>: Is the patient on POLIVY in combination with RITUXAN® (rituximab)</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Yes</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: polivy-receive-copay-for-rituxan</p><p><b>text</b>: Does the patient wish to receive Copay benefits for Rituxan as well</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Yes</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: information-correct</p><p><b>text</b>: All information is correct?</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Yes</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: assign-debitcard</p><p><b>text</b>: Do you require a 16-digit virtual card number to process the claim?</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Yes</td></tr></table></blockquote></div>"
];
fhir:QuestionnaireResponse.questionnaire [
fhir:value "https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/4321";
fhir:link <https://dev.gene.com/fhir/uapi/fhirapi/Questionnaire/4321>
];
fhir:QuestionnaireResponse.status [ fhir:value "completed"];
fhir:QuestionnaireResponse.subject [
fhir:Reference.reference [ fhir:value "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c" ];
fhir:Reference.type [ fhir:value "Patient" ]
];
fhir:QuestionnaireResponse.item [
fhir:index 0;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "consent-to-enroll" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "Does the patient consent to enroll in the Genentech Oncology Co-Pay Program?" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Yes" ] ]
], [
fhir:index 1;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "polivy-fda-approved-indications" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "Is the patient using POLIVY™ (polatuzumab vedotin-piiq) for one of the following FDA-approved indications?" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueCoding [
fhir:Coding.code [ fhir:value "combination" ];
fhir:Coding.display [ fhir:value "POLIVY is a prescription medicine used with other medicines, bendamustine and a rituximab product, to treat diffuse large B-cell lymphoma in adults who have had at least 2 prior therapies.\nThe conditional approval of POLIVY is based on a type of response rate. There are ongoing studies to establish how well the drug works." ] ] ]
], [
fhir:index 2;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "18-years-or-older" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "Is the patient 18 years of age or older" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Yes" ] ]
], [
fhir:index 3;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "commercial-private-insurance" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "Is the patient on commercial (also known as private) insurance? This includes insurance from an employer and non-government funded insurance purchased from a health insurance marketplace" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Yes" ] ]
], [
fhir:index 4;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "federal-state-funded-insurance" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "Is the patient using any federal or state-funded health care program? This includes, but is not limited to, Medicare, Medicaid, Medigap, VA, DoD and TRICARE." ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "No" ] ]
], [
fhir:index 5;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "have-medicare-card" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "Does the patient have a Medicare (red, white and blue) card?" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "No" ] ]
], [
fhir:index 6;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "residence-state" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "What state does the patient live in?" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "DC" ] ]
], [
fhir:index 7;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "receiving-medication-from-gpf" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "Is the patient currently receiving Polivy from the Genentech Patient Foundation?" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "No" ] ]
], [
fhir:index 8;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "receiving-assistance-from-charitable-organization" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "Is the patient currently receiving assistance from any other charitable organization for any of their out-of-pocket costs that are covered by the Genentech Oncology Co-pay Program?" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "No" ] ]
], [
fhir:index 9;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "agree-to-genentech-privacy-policy" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "The patient acknowledges and agrees that any patient information disclosed during the enrollment, including contact information, demographic information, and information related to their medical condition, treatments, and health insurance and benefits, will be shared with Genentech, the sponsor of the program, its partners, and their respective affiliates. In addition, information shared by the pharmacy/physician, such as the date the prescription was filled, the date the medication was administered by the physician (if applicable) and the amount that will be reimbursed by Genentech will also be shared. The patient authorizes Genentech to receive, use, and share patient personal information in connection with the Genentech Oncology Co-pay Program. The patient agrees to be contacted by phone, mail or email about the Genentech Oncology Co-pay Program. You have notified the patient that they can find more information in the Genentech Privacy Policy at www.gene.com/privacy-policy." ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Agree" ] ]
], [
fhir:index 10;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "agree-to-copay-program-terms" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "The Co-pay Program is valid ONLY for patients with commercial (private or non-governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medicine. Patients using Medicare, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD), TRICARE or any other federal or state government program (collectively, “Government Programs”) to pay for their Genentech medicine are not eligible. The Program is not valid for Genentech medicines that are eligible to be reimbursed in their entirety by private insurance plans or other programs.\n\nUnder the Program, the patient may pay a co-pay. The final amount owed by a patient may be as little as $0 for the Genentech medicine (see Program specific details). The total patient out-of-pocket cost is dependent on the patient’s health insurance plan. The Program assists with the cost of the Genentech medicine only. It does not assist with the cost of other medicines, procedures or office visit fees. After reaching the maximum annual Program benefit amount, the patient will be responsible for all remaining out-of-pocket expenses. The Program benefit amount cannot exceed the patient’s out-of-pocket expenses for the cost associated with the Genentech medicine. The maximum Program benefit will reset every January 1st. The Program is not health insurance or a benefit plan. The patient’s non-governmental insurance is the primary payer. The Program does not obligate the use of any specific medicine or provider. Patients receiving assistance from charitable free medicine programs (such as the Genentech Patient Foundation) or any other charitable organizations for the same expenses covered by the Program are not eligible. The Program benefit cannot be combined with any other rebate, free trial or a similar offer for the Genentech medicine. No party may seek reimbursement for all or any part of the benefit received through the Program.\n\nThe Program may be accepted by participating pharmacies, physicians’ offices or hospitals. Once a patient is enrolled, the Program will honor claims with a date of service that precedes the Program enrollment date up to 180 days. Claims must be submitted within 365 days from the date of service unless otherwise indicated. Use of the Program must be consistent with all relevant health insurance requirements. Participating patients, pharmacies, physicians’ offices and hospitals are responsible for reporting the receipt of all Program benefits as required by any insurer or by law. Programs’ benefits may not be sold, purchased, traded or offered for sale.\n\nThe patient or their guardian must be 18 years of age or older to receive Program assistance. The Program is only valid in the United States and U.S. Territories, is void where prohibited by law and shall follow state restrictions in relation to AB-rated generic equivalents (e.g., MA, CA) where applicable. Eligible patients will be automatically re-enrolled in the Program on an annual basis. Eligible patients will be removed from the Program after 3 years of inactivity (e.g., no claims submitted in a 3-year timeframe). Program eligibility and automatic re-enrollment are contingent upon the patient’s ability to meet all requirements set forth by the Program. Healthcare providers may not advertise or otherwise use the Program as a means of promoting their services or Genentech medicines to patients. The Program is intended for the patient. Only the patient using the Program may receive the funds made available through the Program. The Program is not intended for third parties who reduce the amount available to the patient or take a portion for their own purposes. Patients with health plans that redirect Genentech Program assistance intended for patient out-of-pocket costs may be subject to alternate Program benefit structures. Genentech reserves the right to rescind, revoke or amend the Program without notice at any time." ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Agree" ] ]
], [
fhir:index 11;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "polivy-combo-with-rituxan" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "Is the patient on POLIVY in combination with RITUXAN® (rituximab)" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Yes" ] ]
], [
fhir:index 12;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "polivy-receive-copay-for-rituxan" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "Does the patient wish to receive Copay benefits for Rituxan as well" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Yes" ] ]
], [
fhir:index 13;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "information-correct" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "All information is correct?" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Yes" ] ]
], [
fhir:index 14;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "assign-debitcard" ];
fhir:QuestionnaireResponse.item.text [ fhir:value "Do you require a 16-digit virtual card number to process the claim?" ];
fhir:QuestionnaireResponse.item.answer [
fhir:index 0;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Yes" ] ]
].
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fhir:Resource.id [ fhir:value "42b41bdb-1781-49aa-a091-78cdd92129df"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-coverage> ]
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fhir:DomainResource.text [
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];
fhir:Coverage.status [ fhir:value "active"];
fhir:Coverage.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
fhir:Coding.code [ fhir:value "HIP" ];
fhir:Coding.display [ fhir:value "health insurance plan policy" ] ]
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fhir:Coverage.subscriber [
fhir:Reference.reference [ fhir:value "urn:uuid:12ed44e8-fde2-415d-9dcc-8e9117c73d2a" ];
fhir:Reference.type [ fhir:value "RelatedPerson" ]
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fhir:Coverage.beneficiary [
fhir:Reference.reference [ fhir:value "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c" ];
fhir:Reference.type [ fhir:value "Patient" ]
];
fhir:Coverage.period [
fhir:Period.start [ fhir:value "2023-01-01"^^xsd:date ]
];
fhir:Coverage.payor [
fhir:index 0;
fhir:Reference.reference [ fhir:value "urn:uuid:d3637025-883d-4678-9e0a-1d243a338f9f" ];
fhir:Reference.type [ fhir:value "Organization" ]
];
fhir:Coverage.class [
fhir:index 0;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "rxbin" ];
fhir:Coding.display [ fhir:value "RX BIN" ] ] ];
fhir:Coverage.class.value [ fhir:value "K12345" ];
fhir:Coverage.class.name [ fhir:value "BIN" ]
], [
fhir:index 1;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "rxpcn" ];
fhir:Coding.display [ fhir:value "RX PCN" ] ] ];
fhir:Coverage.class.value [ fhir:value "K234516" ];
fhir:Coverage.class.name [ fhir:value "PCN" ]
], [
fhir:index 2;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "group" ];
fhir:Coding.display [ fhir:value "Group" ] ] ];
fhir:Coverage.class.value [ fhir:value "KAI2345" ];
fhir:Coverage.class.name [ fhir:value "Group Number" ]
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fhir:index 3;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "plan" ];
fhir:Coding.display [ fhir:value "Plan" ] ] ];
fhir:Coverage.class.value [ fhir:value "HMO" ];
fhir:Coverage.class.name [ fhir:value "Plan" ]
];
fhir:Coverage.order [ fhir:value "1"^^xsd:positiveInteger];
fhir:Coverage.network [ fhir:value "Kaiser"].
<urn:uuid:d212ac11-903c-4040-a3d7-6b3e1874a311> a fhir:Coverage;
fhir:Resource.id [ fhir:value "d212ac11-903c-4040-a3d7-6b3e1874a311"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-coverage";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-coverage> ]
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fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
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fhir:Coding.display [ fhir:value "drug policy" ] ]
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fhir:Reference.reference [ fhir:value "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c" ];
fhir:Reference.type [ fhir:value "Patient" ]
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fhir:Reference.reference [ fhir:value "urn:uuid:982e97af-668d-41ef-b9f9-2bbc4a059330" ];
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fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "rxbin" ];
fhir:Coding.display [ fhir:value "RX BIN" ] ] ];
fhir:Coverage.class.value [ fhir:value "K3456" ];
fhir:Coverage.class.name [ fhir:value "BIN" ]
], [
fhir:index 1;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "rxpcn" ];
fhir:Coding.display [ fhir:value "RX PCN" ] ] ];
fhir:Coverage.class.value [ fhir:value "K334455" ];
fhir:Coverage.class.name [ fhir:value "PCN" ]
], [
fhir:index 2;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "group" ];
fhir:Coding.display [ fhir:value "Group" ] ] ];
fhir:Coverage.class.value [ fhir:value "KAI2345" ];
fhir:Coverage.class.name [ fhir:value "Group Number" ]
], [
fhir:index 3;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "plan" ];
fhir:Coding.display [ fhir:value "Plan" ] ] ];
fhir:Coverage.class.value [ fhir:value "HMO" ];
fhir:Coverage.class.name [ fhir:value "Plan" ]
];
fhir:Coverage.order [ fhir:value "1"^^xsd:positiveInteger];
fhir:Coverage.network [ fhir:value "CVS Specialty"].
<urn:uuid:226e6ff9-9b26-4d4e-8e5e-e100770d6f4d> a fhir:Task;
fhir:Resource.id [ fhir:value "226e6ff9-9b26-4d4e-8e5e-e100770d6f4d"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Task</b><a name=\"226e6ff9-9b26-4d4e-8e5e-e100770d6f4d\"> </a></p><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\">Resource Task \"226e6ff9-9b26-4d4e-8e5e-e100770d6f4d\" </p></div><p><b>status</b>: requested</p><p><b>intent</b>: plan</p><p><b>code</b>: Copay <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-uapi-sr-type.html\">UAPI Code System - Service Request Type</a>#copay)</span></p><p><b>for</b>: <a href=\"#Patient_fc2e5a72-c363-4616-ae00-4ad25cbcb45c\">See above (urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c)</a></p><p><b>authoredOn</b>: 2023-01-23 08:10:13-0500</p><p><b>requester</b>: <a href=\"#Organization_be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2\">See above (urn:uuid:be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2)</a></p><blockquote><p><b>input</b></p><p><b>type</b>: enroll-by-id <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-copay-task-input-type#enroll-by-id)</span></p><p><b>value</b>: Patient <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-copay-enrollby-id#1)</span></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: brandId <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-copay-task-input-type#brandId)</span></p><p><b>value</b>: 2195a20c-4cd6-47d2-8ff6-f458b89281f4 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-copay-brand-id#2195a20c-4cd6-47d2-8ff6-f458b89281f4)</span></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: brandId <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-copay-task-input-type#brandId)</span></p><p><b>value</b>: e36cda77-1c22-467a-b5fd-18ceddb6b023 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (uapi-copay-brand-id#e36cda77-1c22-467a-b5fd-18ceddb6b023)</span></p></blockquote></div>"
];
fhir:Task.status [ fhir:value "requested"];
fhir:Task.intent [ fhir:value "plan"];
fhir:Task.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://fhir.developer.gene.com/CodeSystem/uapi-sr-type" ];
fhir:Coding.code [ fhir:value "copay" ] ]
];
fhir:Task.for [
fhir:Reference.reference [ fhir:value "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c" ];
fhir:Reference.type [ fhir:value "Patient" ]
];
fhir:Task.authoredOn [ fhir:value "2023-01-23T08:10:13-05:00"^^xsd:dateTime];
fhir:Task.requester [
fhir:Reference.reference [ fhir:value "urn:uuid:be7a688f-cdfd-41f4-9fe1-3e92abbfbbf2" ];
fhir:Reference.type [ fhir:value "Organization" ]
];
fhir:Task.input [
fhir:index 0;
fhir:Task.input.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-task-input-type" ];
fhir:Coding.code [ fhir:value "enroll-by-id" ] ] ];
fhir:Task.input.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-enrollby-id" ];
fhir:Coding.code [ fhir:value "1" ];
fhir:Coding.display [ fhir:value "Patient" ] ] ]
], [
fhir:index 1;
fhir:Task.input.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-task-input-type" ];
fhir:Coding.code [ fhir:value "brandId" ] ] ];
fhir:Task.input.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-brand-id" ];
fhir:Coding.code [ fhir:value "2195a20c-4cd6-47d2-8ff6-f458b89281f4" ] ] ]
], [
fhir:index 2;
fhir:Task.input.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-task-input-type" ];
fhir:Coding.code [ fhir:value "brandId" ] ] ];
fhir:Task.input.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-copay-brand-id" ];
fhir:Coding.code [ fhir:value "e36cda77-1c22-467a-b5fd-18ceddb6b023" ] ] ]
].
<urn:uuid:12ed44e8-fde2-415d-9dcc-8e9117c73d2a> a fhir:RelatedPerson;
fhir:Resource.id [ fhir:value "12ed44e8-fde2-415d-9dcc-8e9117c73d2a"];
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson";
fhir:index 0;
fhir:link <https://fhir.developer.gene.com/StructureDefinition/uapi-relatedPerson> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: RelatedPerson</b><a name=\"12ed44e8-fde2-415d-9dcc-8e9117c73d2a\"> </a></p><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\">Resource RelatedPerson \"12ed44e8-fde2-415d-9dcc-8e9117c73d2a\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-uapi-relatedPerson.html\">UAPI RelatedPerson</a></p></div><p><b>patient</b>: <a href=\"#Patient_fc2e5a72-c363-4616-ae00-4ad25cbcb45c\">See above (urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c)</a></p><p><b>relationship</b>: significant other <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v3-RoleCode.html\">RoleCode</a>#SIGOTHR)</span></p><p><b>name</b>: Bob Paul Smith (OFFICIAL)</p><p><b>telecom</b>: ph: 310-462-1234(MOBILE)</p><p><b>birthDate</b>: 1972-10-29</p><p><b>address</b>: 8 Ranoldo Terrace Cherry Hill NJ 08034 US </p></div>"
];
fhir:RelatedPerson.patient [
fhir:Reference.reference [ fhir:value "urn:uuid:fc2e5a72-c363-4616-ae00-4ad25cbcb45c" ];
fhir:Reference.type [ fhir:value "Patient" ]
];
fhir:RelatedPerson.relationship [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-RoleCode" ];
fhir:Coding.code [ fhir:value "SIGOTHR" ];
fhir:Coding.display [ fhir:value "significant other" ] ]
];
fhir:RelatedPerson.name [
fhir:index 0;
fhir:HumanName.use [ fhir:value "official" ];
fhir:HumanName.family [ fhir:value "Smith" ];
fhir:HumanName.given [
fhir:value "Bob Paul";
fhir:index 0 ]
];
fhir:RelatedPerson.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "phone" ];
fhir:ContactPoint.value [ fhir:value "310-462-1234" ];
fhir:ContactPoint.use [ fhir:value "mobile" ]
];
fhir:RelatedPerson.birthDate [ fhir:value "1972-10-29"^^xsd:date];
fhir:RelatedPerson.address [
fhir:index 0;
fhir:Address.line [
fhir:value "8 Ranoldo Terrace";
fhir:index 0 ];
fhir:Address.city [ fhir:value "Cherry Hill" ];
fhir:Address.state [ fhir:value "NJ" ];
fhir:Address.postalCode [ fhir:value "08034" ];
fhir:Address.country [ fhir:value "US" ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2021+ . Package gene.com.fhir.uapi#1.1.19 based on FHIR 4.3.0. Generated 2024-02-19
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