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Packageca.on.ir.r4
Resource TypeBundle
IdSample-Scenario-5_Historical - Immunization-ICON.json
FHIR VersionR4

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Source1

{
  "resourceType": "Bundle",
  "id": "historical-icon",
  "identifier": {
    "system": "http://ontariohealth.ca/fhir/NamingSystem/ca-on-phu-1234567-bundle-id",
    "value": "bundle-hist-003"
  },
  "type": "document",
  "timestamp": "2024-05-25T12:00:00Z",
  "entry": [
    {
      "fullUrl": "urn:uuid:3c4d5e6f-7a8b-9c0d-1e2f-3a4b5c6d7e8f",
      "resource": {
        "resourceType": "Composition",
        "identifier": {
          "system": "http://ontariohealth.ca/fhir/NamingSystem/ca-on-phu-1234567-composition-id",
          "value": "comp-hist-003"
        },
        "status": "final",
        "type": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "80565-5",
              "display": "Medication administration record"
            }
          ]
        },
        "subject": {
          "reference": "urn:uuid:4d5e6f7a-8b9c-0d1e-2f3a-4b5c6d7e8f9a"
        },
        "date": "2024-05-25T12:00:00Z",
        "author": [
          {
            "reference": "urn:uuid:6f7a8b9c-0d1e-2f3a-4b5c-6d7e8f9a0b1c"
          }
        ],
        "title": "Medication administration record",
        "custodian": {
          "reference": "urn:uuid:1e2d3c4b-5a6f-4789-8a9b-0c1d2e3f4a5b"
        },
        "section": [
          {
            "title": "Medication administration record",
            "code": {
              "coding": [
                {
                  "system": "http://loinc.org",
                  "code": "80565-5",
                  "display": "Medication administration record"
                }
              ]
            },
            "entry": [
              {
                "reference": "urn:uuid:5e6f7a8b-9c0d-1e2f-3a4b-5c6d7e8f9a0b"
              }
            ]
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:4d5e6f7a-8b9c-0d1e-2f3a-4b5c6d7e8f9a",
      "resource": {
        "resourceType": "Patient",
        "id": "patient-ethan",
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "JHN"
                }
              ]
            },
            "system": "https://fhir.infoway-inforoute.ca/NamingSystem/ca-on-patient-hcn",
            "value": "9900112233"
          },
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "MR"
                }
              ]
            },
            "system": "http://ehealthontario.ca/fhir/NamingSystem/id-panorama-mrn",
            "value": "XYZ6000003"
          }
        ],
        "name": [
          {
            "family": "Wallace",
            "given": [
              "Ethan"
            ]
          }
        ],
        "gender": "male",
        "birthDate": "2024-01-25",
        "telecom": [
          {
            "system": "phone",
            "value": "905-555-6003"
          }
        ],
        "address": [
          {
            "line": [
              "45 Lakeshore Rd"
            ],
            "city": "Hamilton",
            "state": "ON",
            "postalCode": "L8E3L5",
            "country": "CAN"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:6f7a8b9c-0d1e-2f3a-4b5c-6d7e8f9a0b1c",
      "resource": {
        "resourceType": "PractitionerRole",
        "practitioner": {
          "reference": "urn:uuid:7a8b9c0d-1e2f-3a4b-5c6d-7e8f9a0b1c2d"
        },
        "organization": {
          "reference": "urn:uuid:1e2d3c4b-5a6f-4789-8a9b-0c1d2e3f4a5b"
        },
        "telecom": [
          {
            "system": "phone",
            "value": "416-555-0198",
            "use": "work"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:7a8b9c0d-1e2f-3a4b-5c6d-7e8f9a0b1c2d",
      "resource": {
        "resourceType": "Practitioner",
        "id": "practitioner-julia",
        "identifier": [
          {
            "system": "https://fhir.infoway-inforoute.ca/NamingSystem/ca-on-license-physician",
            "value": "2220000"
          }
        ],
        "name": [
          {
            "family": "Evans",
            "given": [
              "Julia"
            ],
            "prefix": [
              "MD"
            ]
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:1e2d3c4b-5a6f-4789-8a9b-0c1d2e3f4a5b",
      "resource": {
        "resourceType": "Organization",
        "id": "org-phu",
        "identifier": [
          {
            "system": "https://fhir.infoway-inforoute.ca/NamingSystem/ca-on-license-pharmacist-org",
            "value": "1234567"
          }
        ],
        "name": "Public Health Unit"
      }
    },
    {
      "fullUrl": "urn:uuid:1a2b3c4d-5e6f-7a8b-9c0d-e1f2a3b4c5d6",
      "resource": {
        "resourceType": "Location",
        "id": "loc-icon",
        "name": "Immunization Connect Ontario (ICON)"
      }
    },
    {
      "fullUrl": "urn:uuid:5e6f7a8b-9c0d-1e2f-3a4b-5c6d7e8f9a0b",
      "resource": {
        "resourceType": "Immunization",
        "id": "immz-003",
        "extension": [
          {
            "url": "http://ontariohealth.ca/fhir/ehr/StructureDefinition/ext-immunization-isValid",
            "valueBoolean": true
          }
        ],
        "identifier": [
          {
            "system": "http://ontariohealth.ca/fhir/NamingSystem/ca-on-phu-1234567-immunization-id",
            "value": "ICON-HIST-003"
          }
        ],
        "status": "completed",
        "vaccineCode": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "7811000087105",
              "display": "Vaccine product containing only Rotavirus 1 serotype antigen (medicinal product)"
            }
          ]
        },
        "patient": {
          "reference": "urn:uuid:4d5e6f7a-8b9c-0d1e-2f3a-4b5c6d7e8f9a"
        },
        "occurrenceDateTime": "2024-05-25T12:00:00Z",
        "primarySource": false,
        "location": {
          "reference": "urn:uuid:1a2b3c4d-5e6f-7a8b-9c0d-e1f2a3b4c5d6"
        },
        "site": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "123851003",
              "display": "Mouth region structure (body structure)"
            }
          ]
        },
        "route": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "26643006",
              "display": "Oral route (qualifier value)"
            }
          ]
        },
        "doseQuantity": {
          "value": 1.5,
          "unit": "mL",
          "system": "http://unitsofmeasure.org",
          "code": "mL"
        },
        "performer": [
          {
            "actor": {
              "reference": "urn:uuid:6f7a8b9c-0d1e-2f3a-4b5c-6d7e8f9a0b1c"
            }
          }
        ],
        "reasonCode": [
          {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "8171000087105",
                "display": "Routine immunization (finding)"
              }
            ]
          }
        ],
        "fundingSource": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code": "PUBLICPOL",
              "display": "public healthcare"
            }
          ]
        }
      }
    }
  ]
}