FHIR © HL7.org  |  FHIRsmith 4.0.1  |  Server Home  |  XIG Home  |  XIG Stats  | 

FHIR IG analytics

Packagepharmacyeclaim.trial
Resource TypeBundle
IdClaim Reversal Request.json
FHIR VersionR4

Resources that use this resource

No resources found


Resources that this resource uses

No resources found


Narrative

No narrative content found in resource


Source1

{
  "resourceType": "Bundle",
  "id": "c149ce78-0983-4fc2-ba63-aeac253e933e",
  "meta": {
    "tag": [
      {
        "system": "http://pharmacyeclaims.ca/FHIR/CodeSystem/message-version",
        "code": "1.0"
      }
    ]
  },
  "type": "message",
  "timestamp": "2025-01-06T22:03:23+00:00",
  "entry": [
    {
      "fullUrl": "urn:uuid:6d8041af-7963-4bff-baf4-968d600fbd1e",
      "resource": {
        "resourceType": "MessageHeader",
        "id": "6d8041af-7963-4bff-baf4-968d600fbd1e",
        "eventCoding": {
          "system": "http://pharmacyeclaims.ca/fhir/CodeSystem/message-events",
          "code": "11"
        },
        "destination": [
          {
            "name": "Name of Adjudicator",
            "endpoint": "urn:oid:2.16.840.1.113883.3.7066.1",
            "receiver": {
              "reference": "Organization/12345",
              "identifier": {
                "system": "urn:oid:http://pharmacyeclaims.ca/FHIR/CPHA-identifier/IIN",
                "value": "Device-123"
              }
            }
          }
        ],
        "sender": {
          "reference": "Organization/12345",
          "identifier": {
            "system": "urn:oid:setbyPOSvendor",
            "value": "SoftwareVendorClientName"
          }
        },
        "source": {
          "name": "thename",
          "software": "POS software name",
          "version": "POSversion",
          "endpoint": "urn:uuid:2fcd0a14-4ad6-11e8-9c2d-fa7ae01bbebc"
        },
        "responsible": {
          "reference": "Organization/086968a8c716",
          "identifier": {
            "system": "http://pharmacyeclaims.ca/FHIR/PharmacyID",
            "value": "Device-123"
          }
        },
        "focus": [
          {
            "reference": "urn:uuid:6d8041af-7963-4bff-baf4-968d600fbd1"
          }
        ]
      }
    },
    {
      "fullUrl": "urn:uuid:6d8041af-7963-4bff-baf4-968d600para",
      "resource": {
        "resourceType": "Parameters",
        "id": "6d8041af-7963-4bff-baf4-968d600fpara",
        "parameter": [
          {
            "name": "AdjudicationDate",
            "valueDateTime": "2025-08-01T10:00:00Z"
          },
          {
            "name": "TraceNumber",
            "valueIdentifier": {
              "system": "http://pharmacyeclaims.ca/FHIR/TraceNumber",
              "value": "TRC-9876543210"
            }
          },
          {
            "name": "ReferenceNumber",
            "valueIdentifier": {
              "system": "http://pharmacyeclaims.ca/FHIR/reference",
              "value": "REF-1234567890"
            }
          },
          {
            "name": "CurrentRXNumber",
            "valueIdentifier": {
              "system": "http://pharmacyeclaims.ca/FHIR/rx",
              "value": "RX-00012345"
            }
          },
          {
            "name": "ProviderTransactionDate",
            "valueDateTime": "2025-07-31T14:45:00Z"
          },
          {
            "name": "ClientID",
            "valueIdentifier": {
              "value": "123451234512345"
            }
          }
        ]
      }
    }
  ]
}