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Packageig.fhir-il-community.org.t17
Resource TypeBundle
IdBundle-no-authorization-single-code.json
FHIR VersionR4

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Source1

{
  "resourceType": "Bundle",
  "id": "no-authorization-single-code",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2023-10-30T12:16:52.092+00:00",
    "source": "#OWv6TVW3y30WsF2S"
  },
  "entry": [
    {
      "fullUrl": "urn:uuid:7528e4d8-d2de-4e38-9792-eb0013e0570b",
      "resource": {
        "resourceType": "CoverageEligibilityResponse",
        "id": "90f540a4-f1a8-4a8e-a031-0ed887ce980e",
        "identifier": [
          {
            "system": "urn:ietf:rfc:3986",
            "value": "urn:uuid:90f540a4-f1a8-4a8e-a031-0ed887ce980e"
          }
        ],
        "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": {
              "display": "אין מספר התחייבות"
            },
            "item": [
              {
                "modifier": [
                  {
                    "coding": [
                      {
                        "code": "charge-not-authorized",
                        "system": "http://fhir.health.gov.il/cs/moh-form17-issue-code",
                        "display": "ללקוח אין הרשאת חיוב"
                      }
                    ]
                  }
                ],
                "productOrService": {
                  "coding": [
                    {
                      "code": "L9258",
                      "system": "http://fhir.health.gov.il/cs/medical-service-moh",
                      "display": "בדיקת רופא ילדים במרפאה"
                    }
                  ]
                },
                "excluded": true,
                "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 לא אושרה"
      }
    }
  ],
  "type": "collection"
}