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Packageorg.dhin-hie.sandbox
Resource TypeBundle
IdBundle-NgEligibilityCheck-Response.json
FHIR VersionR4

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Source1

{
  "resourceType": "Bundle",
  "id": "NgEligibilityCheck-Response",
  "meta": {
    "profile": [
      "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-eligibility-check-bundle"
    ]
  },
  "type": "collection",
  "entry": [
    {
      "fullUrl": "urn:uuid:aaabbbcc-e5f6-4789-a123-456789abcdef",
      "resource": {
        "resourceType": "Patient",
        "id": "NgPatient-Elig-001",
        "meta": {
          "lastUpdated": "2024-10-15T09:00:00+01:00",
          "profile": [
            "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-patient"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_NgPatient-Elig-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient NgPatient-Elig-001</b></p><a name=\"NgPatient-Elig-001\"> </a><a name=\"hcNgPatient-Elig-001\"> </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\">Last updated: 2024-10-15 09:00:00+0100</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-patient.html\">NG Patient</a></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Chika Okafor  Male, DoB: 1990-04-21 ( mobile: 08031112233)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Record is active\">Active:</td><td colspan=\"3\">true</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Other Id (see the one above)\">Other Id:</td><td colspan=\"3\">nin/23456565514</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\">21 Industrial Area Port Harcourt RI </td></tr></table></div>"
        },
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "https://sandbox.dhin-hie.org/ig/CodeSystem/patient-identifier-cs",
                  "code": "MOBILE",
                  "display": "mobile"
                }
              ]
            },
            "system": "https://sandbox.dhin-hie.org/ig/CodeSystem/patient-identifier-cs",
            "value": "08031112233"
          },
          {
            "type": {
              "coding": [
                {
                  "system": "https://sandbox.dhin-hie.org/ig/CodeSystem/patient-identifier-cs",
                  "code": "NIN"
                }
              ]
            },
            "system": "https://sandbox.dhin-hie.org/ig/CodeSystem/patient-identifier-cs",
            "value": "23456565514"
          }
        ],
        "active": true,
        "name": [
          {
            "family": "Okafor",
            "given": [
              "Chika"
            ]
          }
        ],
        "gender": "male",
        "birthDate": "1990-04-21",
        "address": [
          {
            "line": [
              "21 Industrial Area"
            ],
            "city": "Port Harcourt",
            "district": "ri-emohua",
            "state": "RI"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:bbbcccdd-e5f6-4789-a123-456789abcdef",
      "resource": {
        "resourceType": "Practitioner",
        "id": "NgPractitioner-Elig-001",
        "meta": {
          "profile": [
            "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-practitioner"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_NgPractitioner-Elig-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner NgPractitioner-Elig-001</b></p><a name=\"NgPractitioner-Elig-001\"> </a><a name=\"hcNgPractitioner-Elig-001\"> </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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-practitioner.html\">NG Practitioner</a></p></div><p><b>identifier</b>: <code>https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-mdcn</code>/MDCN-45231</p><p><b>active</b>: true</p><p><b>name</b>: Elidayo Aderemi </p><p><b>telecom</b>: ph: 08090001111</p><p><b>birthDate</b>: 1985-03-05</p></div>"
        },
        "identifier": [
          {
            "system": "https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-mdcn",
            "value": "MDCN-45231"
          }
        ],
        "active": true,
        "name": [
          {
            "family": "Aderemi",
            "given": [
              "Elidayo"
            ]
          }
        ],
        "telecom": [
          {
            "system": "phone",
            "value": "08090001111"
          }
        ],
        "birthDate": "1985-03-05"
      }
    },
    {
      "fullUrl": "urn:uuid:cccdddee-e5f6-4789-a123-456789abcdef",
      "resource": {
        "resourceType": "Organization",
        "id": "NgOrganization-Hospital-001",
        "meta": {
          "profile": [
            "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-provider-organization"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_NgOrganization-Hospital-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization NgOrganization-Hospital-001</b></p><a name=\"NgOrganization-Hospital-001\"> </a><a name=\"hcNgOrganization-Hospital-001\"> </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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-provider-organization.html\">NG Provider Organization</a></p></div><p><b>identifier</b>: <code>https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry</code>/CLM-2025-0001</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: City General Hospital</p><p><b>telecom</b>: ph: 01-445-7788</p><p><b>address</b>: 25 Hospital Way Port Harcourt RI </p></div>"
        },
        "identifier": [
          {
            "system": "https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry",
            "value": "CLM-2025-0001"
          }
        ],
        "active": true,
        "type": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                "code": "prov",
                "display": "Healthcare Provider"
              }
            ]
          }
        ],
        "name": "City General Hospital",
        "telecom": [
          {
            "system": "phone",
            "value": "01-445-7788"
          }
        ],
        "address": [
          {
            "line": [
              "25 Hospital Way"
            ],
            "city": "Port Harcourt",
            "district": "ri-emohua",
            "state": "RI"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:cccddde1-e5f6-4789-a123-456789abcdef",
      "resource": {
        "resourceType": "Organization",
        "id": "NgOrganization-Insurer-001",
        "meta": {
          "profile": [
            "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-insurer-organization"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_NgOrganization-Insurer-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization NgOrganization-Insurer-001</b></p><a name=\"NgOrganization-Insurer-001\"> </a><a name=\"hcNgOrganization-Insurer-001\"> </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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-insurer-organization.html\">NG Insurer Organization</a></p></div><p><b>identifier</b>: <code>https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry</code>/CLM-2025-0001</p><p><b>active</b>: true</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 HMO</p><p><b>telecom</b>: ph: 01-445-7799</p><p><b>address</b>: 25 Hospital Way Port Harcourt RI </p></div>"
        },
        "identifier": [
          {
            "system": "https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry",
            "value": "CLM-2025-0001"
          }
        ],
        "active": true,
        "type": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                "code": "ins",
                "display": "Insurance Company"
              }
            ]
          }
        ],
        "name": "XYZ HMO",
        "telecom": [
          {
            "system": "phone",
            "value": "01-445-7799"
          }
        ],
        "address": [
          {
            "line": [
              "25 Hospital Way"
            ],
            "city": "Port Harcourt",
            "district": "ri-emohua",
            "state": "RI"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:fffaaabb-e5f6-4789-a123-456789abcdef",
      "resource": {
        "resourceType": "Coverage",
        "id": "NgCoverage-Elig-001",
        "meta": {
          "profile": [
            "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-coverage"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_NgCoverage-Elig-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage NgCoverage-Elig-001</b></p><a name=\"NgCoverage-Elig-001\"> </a><a name=\"hcNgCoverage-Elig-001\"> </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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-coverage.html\">NG Claim Coverage</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode EHCPOL}\">extended healthcare</span></p><p><b>beneficiary</b>: <a href=\"Bundle-NgEligibilityCheck-Request.html#urn-uuid-aaabbbcc-e5f6-4789-a123-456789abcdef\">Chika Okafor  Male, DoB: 1990-04-21 ( mobile: 08031112233)</a></p><p><b>period</b>: 2025-01-01 --&gt; 2025-12-31</p><p><b>payor</b>: <a href=\"Bundle-NgEligibilityCheck-Request.html#urn-uuid-cccddde1-e5f6-4789-a123-456789abcdef\">Organization XYZ HMO</a></p></div>"
        },
        "status": "active",
        "type": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code": "EHCPOL",
              "display": "extended healthcare"
            }
          ]
        },
        "beneficiary": {
          "reference": "urn:uuid:aaabbbcc-e5f6-4789-a123-456789abcdef"
        },
        "period": {
          "start": "2025-01-01",
          "end": "2025-12-31"
        },
        "payor": [
          {
            "reference": "urn:uuid:cccddde1-e5f6-4789-a123-456789abcdef"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:dddeeeff-e5f6-4789-a123-456789abcdef",
      "resource": {
        "resourceType": "CoverageEligibilityRequest",
        "id": "CER-Request-001",
        "meta": {
          "profile": [
            "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-coverage-eligibility-request"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"CoverageEligibilityRequest_CER-Request-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityRequest CER-Request-001</b></p><a name=\"CER-Request-001\"> </a><a name=\"hcCER-Request-001\"> </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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-coverage-eligibility-request.html\">NG Claim Coverage Eligibility Request</a></p></div><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage benefits</p><p><b>patient</b>: <a href=\"Bundle-NgEligibilityCheck-Request.html#urn-uuid-aaabbbcc-e5f6-4789-a123-456789abcdef\">Chika Okafor  Male, DoB: 1990-04-21 ( mobile: 08031112233)</a></p><p><b>created</b>: 2025-10-15 09:05:00+0100</p><p><b>provider</b>: <a href=\"Bundle-NgEligibilityCheck-Request.html#urn-uuid-cccdddee-e5f6-4789-a123-456789abcdef\">Organization City General Hospital</a></p><p><b>insurer</b>: <a href=\"Bundle-NgEligibilityCheck-Request.html#urn-uuid-cccddde1-e5f6-4789-a123-456789abcdef\">Organization XYZ HMO</a></p><p><b>facility</b>: <a href=\"Location-NgLocation-001.html\">Location Asokoro OPD</a></p><h3>Items</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-benefitcategory 1}\">Medical Care</span></td></tr></table></div>"
        },
        "status": "active",
        "purpose": [
          "benefits"
        ],
        "patient": {
          "reference": "urn:uuid:aaabbbcc-e5f6-4789-a123-456789abcdef"
        },
        "created": "2025-10-15T09:05:00+01:00",
        "provider": {
          "reference": "urn:uuid:cccdddee-e5f6-4789-a123-456789abcdef"
        },
        "insurer": {
          "reference": "urn:uuid:cccddde1-e5f6-4789-a123-456789abcdef"
        },
        "facility": {
          "reference": "Location/NgLocation-001"
        },
        "item": [
          {
            "category": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                  "code": "1"
                }
              ]
            }
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:abababab-e5f6-4789-a123-456789abcdef",
      "resource": {
        "resourceType": "CoverageEligibilityResponse",
        "id": "CER-Response-001",
        "meta": {
          "profile": [
            "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-coverage-eligibility-response"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"CoverageEligibilityResponse_CER-Response-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityResponse CER-Response-001</b></p><a name=\"CER-Response-001\"> </a><a name=\"hcCER-Response-001\"> </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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-coverage-eligibility-response.html\">NG Claim Coverage Eligibility Response</a></p></div><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage benefits</p><p><b>patient</b>: <a href=\"Bundle-NgEligibilityCheck-Request.html#urn-uuid-aaabbbcc-e5f6-4789-a123-456789abcdef\">Chika Okafor  Male, DoB: 1990-04-21 ( mobile: 08031112233)</a></p><p><b>created</b>: 2025-10-15 09:06:30+0100</p><p><b>request</b>: <a href=\"Bundle-NgEligibilityCheck-Request.html#urn-uuid-dddeeeff-e5f6-4789-a123-456789abcdef\">CoverageEligibilityRequest: status = active; purpose = benefits; created = 2025-10-15 09:05:00+0100</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Eligible for covered services per active policy.</p><p><b>insurer</b>: <a href=\"Bundle-NgEligibilityCheck-Request.html#urn-uuid-cccddde1-e5f6-4789-a123-456789abcdef\">Organization XYZ HMO</a></p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <a href=\"Bundle-NgEligibilityCheck-Response.html#urn-uuid-fffaaabb-e5f6-4789-a123-456789abcdef\">Coverage: status = active; type = extended healthcare; period = 2025-01-01 --&gt; 2025-12-31</a></p><p><b>inforce</b>: true</p><blockquote><p><b>item</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-benefitcategory 1}\">Outpatient</span></p><h3>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Allowed[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type copay}\">vision-exam</span></td><td>1</td></tr></table></blockquote></blockquote></div>"
        },
        "status": "active",
        "purpose": [
          "benefits"
        ],
        "patient": {
          "reference": "urn:uuid:aaabbbcc-e5f6-4789-a123-456789abcdef"
        },
        "created": "2025-10-15T09:06:30+01:00",
        "request": {
          "reference": "urn:uuid:dddeeeff-e5f6-4789-a123-456789abcdef"
        },
        "outcome": "complete",
        "disposition": "Eligible for covered services per active policy.",
        "insurer": {
          "reference": "urn:uuid:cccddde1-e5f6-4789-a123-456789abcdef"
        },
        "insurance": [
          {
            "coverage": {
              "reference": "urn:uuid:fffaaabb-e5f6-4789-a123-456789abcdef"
            },
            "inforce": true,
            "item": [
              {
                "category": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
                      "code": "1"
                    }
                  ],
                  "text": "Outpatient"
                },
                "benefit": [
                  {
                    "type": {
                      "coding": [
                        {
                          "system": "http://terminology.hl7.org/CodeSystem/benefit-type",
                          "code": "copay"
                        }
                      ],
                      "text": "vision-exam"
                    },
                    "allowedUnsignedInt": 1
                  }
                ]
              }
            ]
          }
        ]
      }
    }
  ]
}