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Packagehl7.fhir.us.pdmp.r4
Resource TypeParameters
IdParameters-pdmp-history-input-parameters-4-delegate.json
FHIR VersionR4

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Source1

{
  "resourceType": "Parameters",
  "id": "pdmp-history-input-parameters-4-delegate",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/pdmp/StructureDefinition/pdmp-parameters-request"
    ]
  },
  "parameter": [
    {
      "name": "patient",
      "resource": {
        "resourceType": "Patient",
        "id": "patient-req-4",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/pdmp/StructureDefinition/pdmp-patient"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient: Jules Julien</div>"
        },
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "MR",
                  "display": "Medical record number"
                }
              ]
            },
            "system": "http://highview-va.example.org/mrn",
            "value": "10035666601"
          }
        ],
        "active": true,
        "name": [
          {
            "family": "Julien",
            "given": [
              "Jules"
            ]
          }
        ],
        "gender": "female",
        "birthDate": "1980-05-20",
        "address": [
          {
            "line": [
              "10023 Santa Clara Blvd"
            ],
            "state": "MA",
            "postalCode": "01742"
          }
        ]
      }
    },
    {
      "name": "authorized-practitioner",
      "resource": {
        "resourceType": "Practitioner",
        "id": "practitioner-req-4",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|6.1.0"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Mari Kimble MD</div>"
        },
        "identifier": [
          {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "1665015602"
          }
        ],
        "name": [
          {
            "family": "Kimble"
          }
        ]
      }
    },
    {
      "name": "authorized-practitioner-role",
      "resource": {
        "resourceType": "PractitionerRole",
        "id": "practitionerrole-req-4",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|6.1.0"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Mari Kimble, Internal Medicine, Highview VA Clinic</div>"
        },
        "practitioner": {
          "reference": "Practitioner/practitioner-req-4",
          "display": "Mari Kimble"
        },
        "organization": {
          "reference": "Organization/organization-req-4",
          "display": "Highview VA Clinic"
        },
        "specialty": [
          {
            "coding": [
              {
                "system": "http://nucc.org/provider-taxonomy",
                "code": "207R00000X",
                "display": "Internal Medicine Physician"
              }
            ]
          }
        ],
        "telecom": [
          {
            "system": "phone",
            "value": "508-856-1234"
          }
        ]
      }
    },
    {
      "name": "authorized-practitioner-organization",
      "resource": {
        "resourceType": "Organization",
        "id": "organization-req-4",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|6.1.0"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Highview VA Clinic</div>"
        },
        "active": true,
        "name": "Highview VA Clinic",
        "telecom": [
          {
            "system": "phone",
            "value": "508-856-5555"
          }
        ],
        "address": [
          {
            "line": [
              "2002 Highview Ln"
            ],
            "city": "Worcester",
            "state": "MA",
            "postalCode": "01604"
          }
        ]
      }
    },
    {
      "name": "delegate-practitioner",
      "resource": {
        "resourceType": "Practitioner",
        "id": "practitioner-req-4-del",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|6.1.0"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Boris Bartok</div>"
        },
        "identifier": [
          {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "1554505606"
          }
        ],
        "name": [
          {
            "family": "Bartok"
          }
        ]
      }
    },
    {
      "name": "delegate-practitioner-role",
      "resource": {
        "resourceType": "PractitionerRole",
        "id": "practitionerrole-req-4-del",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|6.1.0"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Boris Bartok RN, Highview VA Clinic</div>"
        },
        "practitioner": {
          "reference": "Practitioner/practitioner-req-4-del",
          "display": "Mari Kimble"
        },
        "organization": {
          "reference": "Organization/organization-req-4-del",
          "display": "Highview VA Clinic"
        },
        "specialty": [
          {
            "coding": [
              {
                "system": "http://nucc.org/provider-taxonomy",
                "code": "163W00000X",
                "display": "Registered Nurse"
              }
            ]
          }
        ],
        "telecom": [
          {
            "system": "phone",
            "value": "508-856-9999"
          }
        ]
      }
    },
    {
      "name": "delegate-organization",
      "resource": {
        "resourceType": "Organization",
        "id": "organization-req-4-del",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|6.1.0"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Highview VA Clinic</div>"
        },
        "active": true,
        "name": "Highview VA Clinic",
        "telecom": [
          {
            "system": "phone",
            "value": "508-856-5555"
          }
        ],
        "address": [
          {
            "line": [
              "2002 Highview Ln"
            ],
            "city": "Worcester",
            "state": "MA",
            "postalCode": "01604"
          }
        ]
      }
    },
    {
      "name": "pre-stage-only",
      "valueBoolean": false
    }
  ]
}