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Packagehl7.fhir.us.pdmp.r4
Resource TypeBundle
IdBundle-pdmp-bundle-history-result-1.json
FHIR VersionR4

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Source1

{
  "resourceType": "Bundle",
  "id": "pdmp-bundle-history-result-1",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/pdmp/StructureDefinition/pdmp-bundle-history-result"
    ]
  },
  "type": "collection",
  "entry": [
    {
      "fullUrl": "urn:uuid:9ce2a97b-5cab-4986-814f-4734016e6084",
      "resource": {
        "resourceType": "MedicationDispense",
        "id": "meddispense-res-1",
        "meta": {
          "source": "http://example.org/ma-pdmp",
          "profile": [
            "http://hl7.org/fhir/us/pdmp/StructureDefinition/pdmp-medicationdispense"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A record of a medication that was dispensed to the patient identified in the PDMP request: August Samuels</div>"
        },
        "extension": [
          {
            "url": "http://hl7.org/fhir/us/pdmp/StructureDefinition/pdmp-extension-rx-fill-number",
            "valuePositiveInt": 1
          }
        ],
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "FILL",
                  "display": "Filler Identifier"
                }
              ]
            },
            "system": "http://ourpharmacy.com/fillnumber",
            "value": "2000353"
          }
        ],
        "status": "completed",
        "medicationCodeableConcept": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "993781",
              "display": "acetaminophen 300 MG / codeine phosphate 30 MG Oral Tablet"
            },
            {
              "system": "http://hl7.org/fhir/sid/ndc",
              "code": "00093015001",
              "userSelected": true
            }
          ],
          "text": "Acetaminophen 300 mg / Codeine 30 mg oral tablet"
        },
        "subject": {
          "reference": "urn:uuid:53a1e123-5b56-44ae-b7e8-36e0b9800f57",
          "display": "August Samuels"
        },
        "performer": [
          {
            "actor": {
              "reference": "urn:uuid:82ae67e4-f23a-4c17-b80a-9076a37f5d6e",
              "identifier": {
                "system": "http://terminology.hl7.org/CodeSystem/NCPDPProviderIdentificationNumber",
                "value": "999017"
              },
              "display": "Our Pharmacy"
            }
          }
        ],
        "authorizingPrescription": [
          {
            "identifier": {
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                    "code": "PLAC",
                    "display": "Placer Identifier"
                  }
                ]
              },
              "system": "http://myprescribingsystem.com/ordernumber",
              "value": "605153"
            }
          }
        ],
        "quantity": {
          "value": 10,
          "unit": "each"
        },
        "daysSupply": {
          "value": 5
        },
        "whenPrepared": "2023-06-05",
        "whenHandedOver": "2023-06-05",
        "dosageInstruction": [
          {
            "sequence": 1,
            "text": "1 tab tid prn pain"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:53a1e123-5b56-44ae-b7e8-36e0b9800f57",
      "resource": {
        "resourceType": "Patient",
        "id": "patient-res-1-1",
        "meta": {
          "source": "http://example.org/ma-pdmp",
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|6.1.0"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">The PDMP Responder's patient record for the patient identified in the PDMP request: August Samuels</div>"
        },
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "SS"
                }
              ]
            },
            "system": "http://hl7.org/fhir/sid/us-ssn",
            "value": "120-35-2435"
          }
        ],
        "name": [
          {
            "family": "Samuels",
            "given": [
              "August"
            ]
          }
        ],
        "gender": "male",
        "birthDate": "1989-03-12",
        "address": [
          {
            "state": "MA",
            "postalCode": "01059"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:82ae67e4-f23a-4c17-b80a-9076a37f5d6e",
      "resource": {
        "resourceType": "Organization",
        "id": "pharmacy-res-1-1",
        "meta": {
          "source": "http://example.org/ma-pdmp",
          "profile": [
            "http://hl7.org/fhir/us/pdmp/StructureDefinition/pdmp-organization-pharmacy"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">The pharmacy that dispensed the reported medication: Our Pharmacy</div>"
        },
        "identifier": [
          {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "1669512349"
          },
          {
            "system": "http://terminology.hl7.org/CodeSystem/NCPDPProviderIdentificationNumber",
            "value": "999017"
          }
        ],
        "active": true,
        "name": "Our Pharmacy",
        "telecom": [
          {
            "system": "phone",
            "value": "952-555-5555"
          },
          {
            "system": "email",
            "value": "contact-our-pharmacy@email.org"
          }
        ],
        "address": [
          {
            "line": [
              "220 Oak St"
            ],
            "city": "Minneapolis",
            "state": "MN",
            "postalCode": "55008",
            "country": "USA"
          }
        ]
      }
    }
  ]
}