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Packageig.fhir-il-community.org.t17
Resource TypeBundle
IdBundle-partial-authroization-no-commitment-num-multiple-codes.json
FHIR VersionR4

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Source1

{
  "resourceType": "Bundle",
  "id": "partial-authroization-no-commitment-num-multiple-codes",
  "meta": {
    "versionId": "2",
    "lastUpdated": "2023-10-30T10:07:48.561+00:00",
    "source": "#H1ChhZDHHse8X5vL"
  },
  "entry": [
    {
      "fullUrl": "urn:uuid:7528e4d8-d2de-4e38-9792-eb0013e0570b",
      "resource": {
        "resourceType": "CoverageEligibilityResponse",
        "id": "36810080-d753-48e6-9e38-da2cbb73a27b",
        "identifier": [
          {
            "system": "urn:ietf:rfc:3986",
            "value": "urn:uuid:136810080-d753-48e6-9e38-da2cbb73a27b"
          }
        ],
        "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": "התחייבות מאושרת חלקית - ללא מספר התחייבות"
            },
            "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"
              },
              {
                "benefit": [
                  {
                    "type": {
                      "text": "benefit"
                    },
                    "allowedUnsignedInt": 2,
                    "usedUnsignedInt": 1
                  }
                ],
                "productOrService": {
                  "coding": [
                    {
                      "code": "L9261",
                      "system": "http://fhir.health.gov.il/cs/medical-service-moh",
                      "display": "בדיקת רופא כירורג בית החזה במרפאה"
                    }
                  ]
                },
                "excluded": false,
                "name": "בדיקת רופא - התמחות כללית",
                "description": "התמחות כללית"
              },
              {
                "modifier": [
                  {
                    "coding": [
                      {
                        "code": "srv-code-mismatch",
                        "system": "http://fhir.health.gov.il/cs/moh-form17-issue-code",
                        "display": "קוד השירות אינו תואם את הטיפול המתוכנן"
                      }
                    ]
                  }
                ],
                "benefit": [
                  {
                    "type": {
                      "text": "benefit"
                    },
                    "allowedUnsignedInt": 3,
                    "usedUnsignedInt": 2
                  }
                ],
                "productOrService": {
                  "coding": [
                    {
                      "code": "L9266",
                      "system": "http://fhir.health.gov.il/cs/medical-service-moh",
                      "display": "בדיקת רופא כירורג שד במרפאה"
                    }
                  ]
                },
                "excluded": true,
                "name": "בדיקת רופא - התמחות x",
                "description": "התמחות x"
              },
              {
                "modifier": [
                  {
                    "coding": [
                      {
                        "code": "age-limit",
                        "system": "http://fhir.health.gov.il/cs/moh-form17-issue-code",
                        "display": "קוד השירות מוגבל גיל"
                      }
                    ]
                  }
                ],
                "benefit": [
                  {
                    "type": {
                      "text": "benefit"
                    },
                    "allowedUnsignedInt": 4,
                    "usedUnsignedInt": 2
                  }
                ],
                "productOrService": {
                  "coding": [
                    {
                      "code": "99242",
                      "system": "http://fhir.health.gov.il/cs/medical-service-moh",
                      "display": "בדיקת רופא מומחה במרפאה, למעט בדיקות להן קוד מיוחד"
                    }
                  ]
                },
                "excluded": true,
                "name": "בדיקת רופא - התמחות y",
                "description": "התמחות y"
              }
            ]
          }
        ],
        "status": "active",
        "created": "2023-07-02T13:44:58.429Z",
        "outcome": "complete",
        "disposition": "הבקשה להתחייבות אושרה חלקית"
      }
    }
  ],
  "type": "collection"
}