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Source1

{
  "resourceType": "DiagnosticReport",
  "id": "PGxGenomicReportEMERGE",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-report"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-reference",
      "valueReference": {
        "reference": "Procedure/PGXGenomicStudy"
      }
    },
    {
      "url": "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action",
      "valueReference": {
        "reference": "Task/PGxRecEx01",
        "display": "No clopidogrel"
      }
    },
    {
      "url": "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action",
      "valueReference": {
        "reference": "Task/PGxRecEx02",
        "display": "No voriconazole"
      }
    },
    {
      "url": "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action",
      "valueReference": {
        "reference": "Task/PGxRecEx03",
        "display": "50% citalopram"
      }
    },
    {
      "url": "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action",
      "valueReference": {
        "reference": "Task/PGxRecEx04",
        "display": "50% escitalopram"
      }
    },
    {
      "url": "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action",
      "valueReference": {
        "reference": "Task/PGxRecEx04",
        "display": "50% amitriptyline"
      }
    },
    {
      "url": "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-report-note",
      "valueAnnotation": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/annotation-code",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/coded-annotation-types-cs",
                  "code": "test-disclaimer"
                }
              ]
            }
          }
        ],
        "text": "This test was developed and its performance determined by this laboratory. It has not been cleared or approved by U.S. Food and Drug Administration.\nSince FDA Approval is not required for clinical use of this test, this laboratory has established and validated the test's accuracy and precision,\npursuant to the requirement of CLIA '88. This laboratory is licensed and/or accredited under CLIA and CAP (CAP# xxxxxxx / CLIA# xxxxxxxxxx)."
      }
    }
  ],
  "basedOn": [
    {
      "reference": "ServiceRequest/eMERGEServiceRequest"
    }
  ],
  "status": "final",
  "category": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/v2-0074",
          "code": "GE"
        }
      ]
    }
  ],
  "code": {
    "coding": [
      {
        "system": "http://loinc.org",
        "code": "51969-4"
      },
      {
        "system": "http://example.org/hgsc.bcm.edu/lab-test-codes/",
        "code": "emerge-seq-ngs-pnl"
      }
    ]
  },
  "subject": {
    "reference": "Patient/CGPatientExample01"
  },
  "effectiveDateTime": "2020-01-01T00:00:00-05:00",
  "issued": "2020-01-01T00:00:00-05:00",
  "performer": [
    {
      "reference": "Organization/ExampleOrg"
    }
  ],
  "result": [
    {
      "reference": "Observation/TxImp01",
      "display": "clopidogrel, poor metabolizer"
    },
    {
      "reference": "Observation/TxImp02",
      "display": "voriconazole, poor metabolizer"
    },
    {
      "reference": "Observation/TxImp03",
      "display": "citalopram, poor metabolizer"
    },
    {
      "reference": "Observation/TxImp04",
      "display": "escitalopram, poor metabolizer"
    },
    {
      "reference": "Observation/TxImp05",
      "display": "amitriptyline, poor metabolizer"
    },
    {
      "reference": "Observation/TxImp06",
      "display": "medium sensitivity to warfarin"
    },
    {
      "reference": "Observation/Pgx-geno-1001",
      "display": "CYP2C19*2/*2"
    },
    {
      "reference": "Observation/Pgx-geno-1003",
      "display": "VKORC1 rs9923231 C/T"
    },
    {
      "reference": "Observation/Pgx-geno-1002",
      "display": "CYP2C9*1/*1"
    },
    {
      "reference": "Observation/Pgx-var-1011",
      "display": "NC_000010.10(CYP2C19):g.96521657C="
    },
    {
      "reference": "Observation/Pgx-var-1012",
      "display": "NC_000010.10(CYP2C19):g.96522463A="
    },
    {
      "reference": "Observation/Pgx-var-1013",
      "display": "NC_000010.10(CYP2C19):g.96535173T="
    },
    {
      "reference": "Observation/Pgx-var-1014",
      "display": "NC_000010.10(CYP2C19):g.96535210G="
    },
    {
      "reference": "Observation/Pgx-var-1015",
      "display": "NC_000010.10(CYP2C19):g.96540410G>A"
    },
    {
      "reference": "Observation/Pgx-var-1016",
      "display": "NC_000010.10(CYP2C19):g.96541616G="
    },
    {
      "reference": "Observation/Pgx-var-1017",
      "display": "NC_000010.10(CYP2C19):g.96541756T="
    },
    {
      "reference": "Observation/Pgx-var-1018",
      "display": "NC_000010.10(CYP2C19):g.96612495C="
    },
    {
      "reference": "Observation/Pgx-var-1019",
      "display": "NC_000016.9(VKORC1):g.31096368C>T"
    },
    {
      "reference": "Observation/Pgx-var-1020",
      "display": "NC_000010.10(CYP2C9):g.96702047C="
    },
    {
      "reference": "Observation/Pgx-var-1021",
      "display": "NC_000010.10(CYP2C9):g.96741053A="
    }
  ],
  "conclusion": "Based on the genotype result, this patient is predicted to have a CYP2C19 poor metabolizer phenotype. This genotype information can be used by patients and clinicians as part of the shared decision-making process for several drugs metabolized by CYP2C19 including clopidogrel, voriconazole, amitriptyline, citalopram and escitalopram.",
  "conclusionCode": [
    {
      "coding": [
        {
          "system": "http://loinc.org",
          "code": "LA6576-8",
          "display": "Positive"
        }
      ]
    }
  ]
}