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Source1

{
  "resourceType": "Bundle",
  "id": "authroization-with-commitment-num-single-code",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2023-10-30T12:14:35.377+00:00",
    "source": "#DlWFKilqJGbOoSdZ"
  },
  "entry": [
    {
      "fullUrl": "urn:uuid:7528e4d8-d2de-4e38-9792-eb0013e0570b",
      "resource": {
        "resourceType": "CoverageEligibilityResponse",
        "id": "106917e1-a8e6-4ead-b419-83e7a43c9c4d",
        "identifier": [
          {
            "system": "urn:ietf:rfc:3986",
            "value": "urn:uuid:106917e1-a8e6-4ead-b419-83e7a43c9c4d"
          }
        ],
        "purpose": [
          "validation"
        ],
        "patient": {
          "identifier": {
            "system": "http://fhir.leumit.co.il/identifier/magnetic-card",
            "value": "1-123456-123456-789"
          }
        },
        "requestor": {
          "identifier": {
            "system": "http://fhir.health.gov.il/identifier/legal-entity",
            "value": "500106919"
          },
          "type": "Organization",
          "display": "בי\"ח איכילוב"
        },
        "request": {
          "identifier": {
            "system": "http://fhir.tlvmc.gov.il/identifier/preauth-req-no",
            "value": "3772"
          }
        },
        "insurer": {
          "identifier": {
            "system": "http://fhir.health.gov.il/identifier/legal-entity",
            "value": "580039899"
          },
          "display": "לאומית"
        },
        "insurance": [
          {
            "coverage": {
              "identifier": {
                "system": "http://fhir.leumit.co.il/identifier/obligation-num",
                "value": "1-1222223"
              },
              "reference": "Coverage/3819"
            },
            "benefitPeriod": {
              "start": "2023-09-01",
              "end": "2023-10-01"
            },
            "item": [
              {
                "benefit": [
                  {
                    "type": {
                      "text": "benefit"
                    },
                    "allowedUnsignedInt": 3,
                    "usedUnsignedInt": 1
                  }
                ],
                "productOrService": {
                  "coding": [
                    {
                      "code": "L9258",
                      "system": "http://fhir.health.gov.il/cs/medical-service-moh",
                      "display": "בדיקת רופא ילדים במרפאה"
                    }
                  ]
                },
                "excluded": false,
                "name": "בדיקת רופא - התמחות בכליות",
                "description": "בדיקת רופא ילדים עם התמחות לכליות"
              }
            ]
          }
        ],
        "status": "active",
        "created": "2023-07-02T13:44:58.429Z",
        "outcome": "complete",
        "disposition": "הבקשה להתחייבות אושרה"
      }
    },
    {
      "fullUrl": "urn:uuid:1f8407ea-c10d-481e-9cef-829bc2560b6f",
      "resource": {
        "resourceType": "DocumentReference",
        "id": "Inline-Instance-for-4153-2",
        "identifier": [
          {
            "system": "urn:ietf:rfc:3986",
            "value": "urn:uuid:cb512709-9276-4afd-9271-4990e5ef2889"
          }
        ],
        "type": {
          "coding": [
            {
              "code": "64291-8",
              "system": "http://loinc.org",
              "display": "Health insurance-related form"
            }
          ],
          "text": "מסמך התחייבות מאושרת"
        },
        "subject": {
          "identifier": {
            "system": "http://fhir.leumit.co.il/identifier/magnetic-card",
            "value": "1-123456-123456-789"
          },
          "type": "Patient"
        },
        "authenticator": {
          "identifier": {
            "system": "http://fhir.health.gov.il/identifier/legal-entity",
            "value": "580039899"
          },
          "type": "Organization",
          "display": "לאומית"
        },
        "content": [
          {
            "attachment": {
              "contentType": "application/pdf",
              "url": "http://example.org/xds/mhd/Binary/07a6483f-732b-461e-86b6-edb665c45510"
            }
          }
        ],
        "context": {
          "related": [
            {
              "reference": "Coverage/3819",
              "type": "Coverage"
            }
          ]
        },
        "status": "current",
        "date": "2023-07-04T05:02:03.001Z",
        "description": "מסמך אישור התחייבות לקבלת שירות בבית החולים"
      }
    },
    {
      "fullUrl": "http://hapi-fhir.outburn.co.il/fhir/Coverage/3819",
      "resource": {
        "resourceType": "Coverage",
        "id": "3819",
        "identifier": [
          {
            "system": "http://fhir.leumit.co.il/identifier/obligation-num",
            "value": "1-1222223"
          }
        ],
        "beneficiary": {
          "identifier": {
            "system": "http://fhir.leumit.co.il/identifier/magnetic-card",
            "value": "1-123456-123456-789"
          }
        },
        "period": {
          "start": "2023-09-01",
          "end": "2023-10-01"
        },
        "payor": [
          {
            "identifier": {
              "system": "http://fhir.health.gov.il/identifier/legal-entity",
              "value": "580039899"
            },
            "display": "לאומית"
          }
        ],
        "class": [
          {
            "type": {
              "coding": [
                {
                  "code": "OBL-BASKET",
                  "system": "http://fhir.health.gov.il/cs/coverage-class"
                }
              ]
            },
            "value": "התחייבות במסגרת הסל"
          }
        ],
        "costToBeneficiary": [
          {
            "type": {
              "coding": [
                {
                  "code": "deductible",
                  "system": "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
                  "display": "Deductible"
                }
              ],
              "text": "גובה השתתפות עצמית"
            },
            "valueMoney": {
              "value": 200,
              "currency": "ILS"
            }
          }
        ],
        "status": "active",
        "type": {
          "coding": [
            {
              "code": "OBL",
              "system": "http://fhir.health.gov.il/cs/coverage-type",
              "display": "התחייבות"
            }
          ]
        }
      }
    }
  ],
  "type": "collection"
}