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Packagendhm.in
Resource TypeBundle
IdBundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.json
FHIR VersionR4

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Source1

{
  "resourceType": "Bundle",
  "id": "CoverageEligibilityRequestBundle-auth-requirement-example-01",
  "meta": {
    "profile": [
      "https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityRequestBundle"
    ]
  },
  "identifier": {
    "value": "bc3c6c57-2053-4d0e-ac40-139ccccff645"
  },
  "type": "collection",
  "timestamp": "2025-03-07T15:32:26.605+05:30",
  "entry": [
    {
      "fullUrl": "urn:uuid:a752531b-67ad-4b33-9a8b-e1b9229d1505",
      "resource": {
        "resourceType": "CoverageEligibilityRequest",
        "id": "a752531b-67ad-4b33-9a8b-e1b9229d1505",
        "meta": {
          "profile": [
            "https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityRequest"
          ]
        },
        "language": "en",
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><a name=\"CoverageEligibilityRequest_a752531b-67ad-4b33-9a8b-e1b9229d1505\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityRequest a752531b-67ad-4b33-9a8b-e1b9229d1505</b></p><a name=\"a752531b-67ad-4b33-9a8b-e1b9229d1505\"> </a><a name=\"hca752531b-67ad-4b33-9a8b-e1b9229d1505\"> </a><a name=\"a752531b-67ad-4b33-9a8b-e1b9229d1505-hi-IN\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Language: en</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-CoverageEligibilityRequest.html\">CoverageEligibilityRequest</a></p></div><p><b>identifier</b>: 7612345</p><p><b>status</b>: Active</p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><p><b>purpose</b>: Coverage auth-requirements</p><p><b>patient</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-a4dbd17d-35f8-4f36-9dac-f276fa75a4c8\">Patient</a></p><p><b>created</b>: 2025-03-07 11:01:00+0500</p><p><b>enterer</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-9ee37afe-e35a-4ee8-80b1-7f4786cdd507\">Practitioner</a></p><p><b>provider</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-48d6ee22-e2bf-427e-878a-19b5f264f46a\">Organization</a></p><p><b>insurer</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-66ec8a06-3a04-454e-bace-0ad07f70405a\">Organization</a></p><p><b>facility</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-ea4f766b-b7c1-476a-8f19-095928b65ca5\">Location</a></p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>true</td><td><a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-462d36b1-4171-4ebb-871d-94fdb3f7eb11\">Coverage</a></td></tr></table><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 768839008}\">Consultant</span></p><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10 E11.9}\">Type 2 diabetes mellitus : Without complications</span></td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 765507008}\">Metformin hydrochloride 500 mg prolonged-release oral tablet</span></p><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10 E11.9}\">Type 2 diabetes mellitus : Without complications</span></td></tr></table></blockquote></div>"
        },
        "identifier": [
          {
            "value": "7612345"
          }
        ],
        "status": "active",
        "priority": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/processpriority",
              "code": "normal",
              "display": "Normal"
            }
          ]
        },
        "purpose": [
          "auth-requirements"
        ],
        "patient": {
          "reference": "urn:uuid:a4dbd17d-35f8-4f36-9dac-f276fa75a4c8",
          "display": "Patient"
        },
        "created": "2025-03-07T11:01:00+05:00",
        "enterer": {
          "reference": "urn:uuid:9ee37afe-e35a-4ee8-80b1-7f4786cdd507",
          "display": "Practitioner"
        },
        "provider": {
          "reference": "urn:uuid:48d6ee22-e2bf-427e-878a-19b5f264f46a",
          "display": "Organization"
        },
        "insurer": {
          "reference": "urn:uuid:66ec8a06-3a04-454e-bace-0ad07f70405a",
          "display": "Organization"
        },
        "facility": {
          "reference": "urn:uuid:ea4f766b-b7c1-476a-8f19-095928b65ca5",
          "display": "Location"
        },
        "insurance": [
          {
            "focal": true,
            "coverage": {
              "reference": "urn:uuid:462d36b1-4171-4ebb-871d-94fdb3f7eb11",
              "display": "Coverage"
            }
          }
        ],
        "item": [
          {
            "productOrService": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "768839008",
                  "display": "Consultant"
                }
              ]
            },
            "diagnosis": [
              {
                "diagnosisCodeableConcept": {
                  "coding": [
                    {
                      "system": "http://hl7.org/fhir/sid/icd-10",
                      "code": "E11.9",
                      "display": "Type 2 diabetes mellitus : Without complications"
                    }
                  ]
                }
              }
            ]
          },
          {
            "productOrService": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "765507008",
                  "display": "Metformin hydrochloride 500 mg prolonged-release oral tablet"
                }
              ]
            },
            "diagnosis": [
              {
                "diagnosisCodeableConcept": {
                  "coding": [
                    {
                      "system": "http://hl7.org/fhir/sid/icd-10",
                      "code": "E11.9",
                      "display": "Type 2 diabetes mellitus : Without complications"
                    }
                  ]
                }
              }
            ]
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:a4dbd17d-35f8-4f36-9dac-f276fa75a4c8",
      "resource": {
        "resourceType": "Patient",
        "id": "a4dbd17d-35f8-4f36-9dac-f276fa75a4c8",
        "meta": {
          "profile": [
            "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_a4dbd17d-35f8-4f36-9dac-f276fa75a4c8\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient a4dbd17d-35f8-4f36-9dac-f276fa75a4c8</b></p><a name=\"a4dbd17d-35f8-4f36-9dac-f276fa75a4c8\"> </a><a name=\"hca4dbd17d-35f8-4f36-9dac-f276fa75a4c8\"> </a><a name=\"a4dbd17d-35f8-4f36-9dac-f276fa75a4c8-hi-IN\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Adarsh Agrawal Male, DoB: 1981-01-12 ( Adhaar number: 7225-4829-5255)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\"><a href=\"tel:+919818512600\">+919818512600</a></td></tr></table></div>"
        },
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
                  "code": "ADN",
                  "display": "Adhaar number"
                }
              ]
            },
            "system": "https://uidai.gov.in/",
            "value": "7225-4829-5255"
          }
        ],
        "name": [
          {
            "text": "Adarsh Agrawal"
          }
        ],
        "telecom": [
          {
            "system": "phone",
            "value": "+919818512600",
            "use": "home"
          }
        ],
        "gender": "male",
        "birthDate": "1981-01-12"
      }
    },
    {
      "fullUrl": "urn:uuid:9ee37afe-e35a-4ee8-80b1-7f4786cdd507",
      "resource": {
        "resourceType": "Practitioner",
        "id": "9ee37afe-e35a-4ee8-80b1-7f4786cdd507",
        "meta": {
          "profile": [
            "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_9ee37afe-e35a-4ee8-80b1-7f4786cdd507\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner 9ee37afe-e35a-4ee8-80b1-7f4786cdd507</b></p><a name=\"9ee37afe-e35a-4ee8-80b1-7f4786cdd507\"> </a><a name=\"hc9ee37afe-e35a-4ee8-80b1-7f4786cdd507\"> </a><a name=\"9ee37afe-e35a-4ee8-80b1-7f4786cdd507-hi-IN\"> </a><p><b>identifier</b>: Medical License number/21-1521-3828-3227</p><p><b>name</b>: Dr. Aayush Agrawal</p></div>"
        },
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "MD",
                  "display": "Medical License number"
                }
              ]
            },
            "system": "https://doctor.ndhm.gov.in",
            "value": "21-1521-3828-3227"
          }
        ],
        "name": [
          {
            "text": "Dr. Aayush Agrawal"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:66ec8a06-3a04-454e-bace-0ad07f70405a",
      "resource": {
        "resourceType": "Organization",
        "id": "66ec8a06-3a04-454e-bace-0ad07f70405a",
        "meta": {
          "profile": [
            "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_66ec8a06-3a04-454e-bace-0ad07f70405a\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization 66ec8a06-3a04-454e-bace-0ad07f70405a</b></p><a name=\"66ec8a06-3a04-454e-bace-0ad07f70405a\"> </a><a name=\"hc66ec8a06-3a04-454e-bace-0ad07f70405a\"> </a><a name=\"66ec8a06-3a04-454e-bace-0ad07f70405a-hi-IN\"> </a><p><b>identifier</b>: Registry of Hospitals in Network of Insurance (ROHINI) ID/4567878</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type ins}\">Insurance Company</span></p><p><b>name</b>: XYZ Insurance Co. Ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341234\">+91 243 2634 1234</a>, <a href=\"mailto:contact@xyz.org\">contact@xyz.org</a></p></div>"
        },
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
                  "code": "ROHINI",
                  "display": "Registry of Hospitals in Network of Insurance (ROHINI) ID"
                }
              ]
            },
            "system": "https://rohini.iib.gov.in/",
            "value": "4567878"
          }
        ],
        "type": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                "code": "ins",
                "display": "Insurance Company"
              }
            ]
          }
        ],
        "name": "XYZ Insurance Co. Ltd.",
        "telecom": [
          {
            "system": "phone",
            "value": "+91 243 2634 1234",
            "use": "work"
          },
          {
            "system": "email",
            "value": "contact@xyz.org",
            "use": "work"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:48d6ee22-e2bf-427e-878a-19b5f264f46a",
      "resource": {
        "resourceType": "Organization",
        "id": "48d6ee22-e2bf-427e-878a-19b5f264f46a",
        "meta": {
          "profile": [
            "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_48d6ee22-e2bf-427e-878a-19b5f264f46a\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization 48d6ee22-e2bf-427e-878a-19b5f264f46a</b></p><a name=\"48d6ee22-e2bf-427e-878a-19b5f264f46a\"> </a><a name=\"hc48d6ee22-e2bf-427e-878a-19b5f264f46a\"> </a><a name=\"48d6ee22-e2bf-427e-878a-19b5f264f46a-hi-IN\"> </a><p><b>identifier</b>: Provider number/1234567890</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: XYZ Hospital Co. Ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341278\">+91 243 2634 1278</a>, <a href=\"mailto:contact@xyz.org\">contact@xyz.org</a></p></div>"
        },
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "PRN",
                  "display": "Provider number"
                }
              ]
            },
            "system": "https://facility.ndhm.gov.in",
            "value": "1234567890"
          }
        ],
        "type": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                "code": "prov",
                "display": "Healthcare Provider"
              }
            ]
          }
        ],
        "name": "XYZ Hospital Co. Ltd.",
        "telecom": [
          {
            "system": "phone",
            "value": "+91 243 2634 1278",
            "use": "work"
          },
          {
            "system": "email",
            "value": "contact@xyz.org",
            "use": "work"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:ea4f766b-b7c1-476a-8f19-095928b65ca5",
      "resource": {
        "resourceType": "Location",
        "id": "ea4f766b-b7c1-476a-8f19-095928b65ca5",
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Location_ea4f766b-b7c1-476a-8f19-095928b65ca5\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Location ea4f766b-b7c1-476a-8f19-095928b65ca5</b></p><a name=\"ea4f766b-b7c1-476a-8f19-095928b65ca5\"> </a><a name=\"hcea4f766b-b7c1-476a-8f19-095928b65ca5\"> </a><a name=\"ea4f766b-b7c1-476a-8f19-095928b65ca5-hi-IN\"> </a><p><b>identifier</b>: B1-S.F2</p><p><b>status</b>: Active</p><p><b>name</b>: South Wing, second floor</p><p><b>alias</b>: XYZ Life Hospital Co. Ltd., South Wing, second floor</p><p><b>description</b>: Second floor of the Old South Wing, formerly in use by Psychiatry</p><p><b>mode</b>: Instance</p><p><b>telecom</b>: ph: 2328(Work), fax: 2329(Work), <a href=\"http://sampleorg.com/southwing\">http://sampleorg.com/southwing</a></p><p><b>address</b>: 91, Building A Pune 451855 IND (work)</p><p><b>physicalType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/location-physical-type wi}\">Wing</span></p><h3>Positions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Longitude</b></td><td><b>Latitude</b></td><td><b>Altitude</b></td></tr><tr><td style=\"display: none\">*</td><td>-83.6945691</td><td>42.25475478</td><td>0</td></tr></table><p><b>managingOrganization</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-48d6ee22-e2bf-427e-878a-19b5f264f46a\">Organization</a></p></div>"
        },
        "identifier": [
          {
            "value": "B1-S.F2"
          }
        ],
        "status": "active",
        "name": "South Wing, second floor",
        "alias": [
          "XYZ Life Hospital Co. Ltd., South Wing, second floor"
        ],
        "description": "Second floor of the Old South Wing, formerly in use by Psychiatry",
        "mode": "instance",
        "telecom": [
          {
            "system": "phone",
            "value": "2328",
            "use": "work"
          },
          {
            "system": "fax",
            "value": "2329",
            "use": "work"
          },
          {
            "system": "url",
            "value": "http://sampleorg.com/southwing",
            "use": "work"
          }
        ],
        "address": {
          "use": "work",
          "line": [
            "91, Building A"
          ],
          "city": "Pune",
          "postalCode": "451855",
          "country": "IND"
        },
        "physicalType": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/location-physical-type",
              "code": "wi",
              "display": "Wing"
            }
          ]
        },
        "position": {
          "longitude": -83.6945691,
          "latitude": 42.25475478,
          "altitude": 0
        },
        "managingOrganization": {
          "reference": "urn:uuid:48d6ee22-e2bf-427e-878a-19b5f264f46a",
          "display": "Organization"
        }
      }
    },
    {
      "fullUrl": "urn:uuid:462d36b1-4171-4ebb-871d-94fdb3f7eb11",
      "resource": {
        "resourceType": "Coverage",
        "id": "462d36b1-4171-4ebb-871d-94fdb3f7eb11",
        "meta": {
          "profile": [
            "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_462d36b1-4171-4ebb-871d-94fdb3f7eb11\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage 462d36b1-4171-4ebb-871d-94fdb3f7eb11</b></p><a name=\"462d36b1-4171-4ebb-871d-94fdb3f7eb11\"> </a><a name=\"hc462d36b1-4171-4ebb-871d-94fdb3f7eb11\"> </a><a name=\"462d36b1-4171-4ebb-871d-94fdb3f7eb11-hi-IN\"> </a><p><b>identifier</b>: <code>https://xyzinsurance.in/policynumber/</code>/235037120</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span></p><p><b>subscriber</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-a4dbd17d-35f8-4f36-9dac-f276fa75a4c8\">Patient</a></p><p><b>subscriberId</b>: ABC123456BI007</p><p><b>beneficiary</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-a4dbd17d-35f8-4f36-9dac-f276fa75a4c8\">Patient</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: ?? --&gt; 2026-03-17</p><p><b>payor</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-66ec8a06-3a04-454e-bace-0ad07f70405a\">Organization</a></p></div>"
        },
        "identifier": [
          {
            "system": "https://xyzinsurance.in/policynumber/",
            "value": "235037120"
          }
        ],
        "status": "active",
        "type": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code": "HIP",
              "display": "health insurance plan policy"
            }
          ]
        },
        "subscriber": {
          "reference": "urn:uuid:a4dbd17d-35f8-4f36-9dac-f276fa75a4c8",
          "display": "Patient"
        },
        "subscriberId": "ABC123456BI007",
        "beneficiary": {
          "reference": "urn:uuid:a4dbd17d-35f8-4f36-9dac-f276fa75a4c8",
          "display": "Patient"
        },
        "relationship": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
              "code": "self"
            }
          ]
        },
        "period": {
          "end": "2026-03-17"
        },
        "payor": [
          {
            "reference": "urn:uuid:66ec8a06-3a04-454e-bace-0ad07f70405a",
            "display": "Organization"
          }
        ]
      }
    }
  ]
}