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Packageig.fhir-il-community.org.t17
Resource TypeBundle
IdBundle-cancellation-request-multiple-codes.json
FHIR VersionR4

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Source1

{
  "resourceType": "Bundle",
  "id": "cancellation-request-multiple-codes",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2023-07-20T12:21:34.190+00:00",
    "source": "#XilFlMo7DOtpxLzY"
  },
  "entry": [
    {
      "fullUrl": "urn:uuid:3f003001-01cb-4f76-ada7-6d0bc6d04f62",
      "resource": {
        "resourceType": "CoverageEligibilityRequest",
        "id": "Inline-Instance-for-3822-1",
        "identifier": [
          {
            "system": "http://fhir.tlvmc.gov.il/identifier/preauth-req-no",
            "value": "3773"
          }
        ],
        "purpose": [
          "validation"
        ],
        "patient": {
          "identifier": {
            "system": "http://fhir.leumit.co.il/identifier/magnetic-card",
            "value": "1-123456-123456-789"
          }
        },
        "provider": {
          "identifier": {
            "system": "http://fhir.health.gov.il/identifier/legal-entity",
            "value": "500106919"
          },
          "type": "Organization",
          "display": "בי\"ח איכילוב"
        },
        "insurer": {
          "identifier": {
            "system": "http://fhir.health.gov.il/identifier/legal-entity",
            "value": "5899584495"
          },
          "display": "מאוחדת"
        },
        "supportingInfo": [
          {
            "information": {
              "identifier": {
                "system": "http://fhir.tlvmc.gov.il/identifier/preauth-req-no",
                "value": "3772"
              },
              "type": "CoverageEligibilityRequest",
              "display": "בקשת ההתחייבות המבוטלת"
            },
            "sequence": 1
          }
        ],
        "item": [
          {
            "quantity": {
              "value": 2
            },
            "unitPrice": {
              "value": 210,
              "currency": "ILS"
            },
            "productOrService": {
              "coding": [
                {
                  "code": "L9258",
                  "system": "http://fhir.health.gov.il/cs/medical-service-moh",
                  "display": "בדיקת רופא ילדים במרפאה"
                }
              ]
            }
          },
          {
            "quantity": {
              "value": 1
            },
            "unitPrice": {
              "value": 242,
              "currency": "ILS"
            },
            "productOrService": {
              "coding": [
                {
                  "code": "L9261",
                  "system": "http://fhir.health.gov.il/cs/medical-service-moh",
                  "display": "בדיקת רופא כירורג בית החזה במרפאה"
                }
              ]
            }
          },
          {
            "quantity": {
              "value": 2
            },
            "unitPrice": {
              "value": 136,
              "currency": "ILS"
            },
            "productOrService": {
              "coding": [
                {
                  "code": "L9266",
                  "system": "http://fhir.health.gov.il/cs/medical-service-moh",
                  "display": "בדיקת רופא כירורג שד במרפאה"
                }
              ]
            }
          },
          {
            "quantity": {
              "value": 2
            },
            "unitPrice": {
              "value": 80,
              "currency": "ILS"
            },
            "productOrService": {
              "coding": [
                {
                  "code": "99242",
                  "system": "http://fhir.health.gov.il/cs/medical-service-moh",
                  "display": "בדיקת רופא מומחה במרפאה, למעט בדיקות להן קוד מיוחד"
                }
              ]
            }
          }
        ],
        "status": "cancelled",
        "servicedDate": "2023-07-02",
        "created": "2023-07-18T07:51:20.001Z"
      }
    }
  ],
  "type": "collection"
}