Sample Outputs
See real FHIR bundle outputs from healthcare data transformations.
Overview
These examples show actual FHIR R4 bundle outputs generated by InteropSuite from real-world healthcare messages. All outputs conform to US Core 6.1.0 profiles.
Abbreviated Examples
The JSON outputs shown are abbreviated for readability. Actual bundles contain complete resource data with all mapped fields, extensions, and references.
HL7 v2.x Samples
ADT (Admission/Discharge/Transfer) messages transform into Patient, Encounter, and related clinical resources.
Input: HL7 ADT^A01
MSH|^~\&|EPIC|HOSPITAL|RECEIVER|REC|20231215120000||ADT^A01|MSG001|P|2.5.1
EVN|A01|20231215120000
PID|||PAT123456^^^MRN||SMITH^WILLIAM^A^^III||19610615|M|||
1200 N ELM STREET^^JERUSALEM^TN^99999||
(999)999-1212^HOME|(999)999-3333^WORK||||123456789
PV1||I|2000^2012^01||||004777^CASTRO^FRANK^J^^^MD^^^NPI|||MED||||
ADM|||004777^CASTRO^FRANK^J^^^MD^^^NPI|IP||||||||||||||||||||||
|||||20231215080000
DG1|1||I10^ESSENTIAL HYPERTENSION^ICD10|||A
DG1|2||E11.9^TYPE 2 DIABETES^ICD10|||A
AL1|1|DA|PEANUTS^PEANUT ALLERGY||SEVERE|ANAPHYLAXIS
IN1|1||GRP123|BLUE CROSS|PO BOX 1000^^CITY^CA^90001|||GRP456||
Output: FHIR Bundle
{
"resourceType": "Bundle",
"id": "adt-MSG001",
"type": "collection",
"timestamp": "2023-12-15T12:00:00Z",
"entry": [
{
"fullUrl": "Patient/4f22acc9-a179-4783-1897-82c6ef2c5bf7",
"resource": {
"resourceType": "Patient",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
]
},
"identifier": [
{
"system": "urn:oid:2.16.840.1.113883.4.1",
"value": "PAT123456"
}
],
"name": [{
"use": "official",
"family": "SMITH",
"given": ["WILLIAM", "A"],
"suffix": ["III"]
}],
"gender": "male",
"birthDate": "1961-06-15",
"address": [{
"use": "home",
"line": ["1200 N ELM STREET"],
"city": "JERUSALEM",
"state": "TN",
"postalCode": "99999"
}],
"telecom": [
{"system": "phone", "value": "(999)999-1212", "use": "home"},
{"system": "phone", "value": "(999)999-3333", "use": "work"}
]
}
},
{
"fullUrl": "Encounter/c0cc6849-2e8c-f62d-2ed1-487d1d22fa21",
"resource": {
"resourceType": "Encounter",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"
]
},
"status": "in-progress",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "IMP",
"display": "inpatient encounter"
},
"type": [{
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/v2-0004",
"code": "I",
"display": "Inpatient"
}]
}],
"subject": {
"reference": "Patient/4f22acc9-a179-4783-1897-82c6ef2c5bf7"
},
"participant": [{
"type": [{
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "ATND"
}]
}],
"individual": {
"reference": "Practitioner/004777",
"display": "CASTRO, FRANK J."
}
}],
"location": [{
"location": {
"display": "2000, Room 2012, Bed 01"
}
}]
}
},
{
"fullUrl": "Condition/dx-1",
"resource": {
"resourceType": "Condition",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis"
]
},
"code": {
"coding": [{
"system": "http://hl7.org/fhir/sid/icd-10-cm",
"code": "I10",
"display": "Essential Hypertension"
}]
},
"subject": {"reference": "Patient/4f22acc9-a179-4783-1897-82c6ef2c5bf7"}
}
},
{
"fullUrl": "AllergyIntolerance/al-1",
"resource": {
"resourceType": "AllergyIntolerance",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance"
]
},
"clinicalStatus": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
"code": "active"
}]
},
"category": ["food"],
"criticality": "high",
"code": {
"coding": [{
"system": "http://snomed.info/sct",
"code": "91935009",
"display": "Allergy to peanut"
}]
},
"patient": {"reference": "Patient/4f22acc9-a179-4783-1897-82c6ef2c5bf7"},
"reaction": [{
"manifestation": [{
"coding": [{
"display": "Anaphylaxis"
}]
}],
"severity": "severe"
}]
}
}
]
}
Patient 1
Encounter 1
Condition 2
AllergyIntolerance 1
Coverage 1
Practitioner 1
Provenance 1
Input: HL7 ORU^R01
MSH|^~\&|LAB|HOSPITAL|EHR|CLINIC|20231215143000||ORU^R01|LAB001|P|2.5.1
PID|||PAT789^^^MRN||DOE^JANE||19800520|F
OBR|1|ORD001|FIL001|80053^COMPREHENSIVE METABOLIC PANEL^CPT|||
20231215100000|||||||20231215120000||1234567^JONES^ROBERT^^^MD
OBX|1|NM|2345-7^GLUCOSE^LN||105|mg/dL|70-100|H|||F|||20231215120000
OBX|2|NM|2160-0^CREATININE^LN||1.2|mg/dL|0.7-1.3|N|||F|||20231215120000
OBX|3|NM|17861-6^CALCIUM^LN||9.5|mg/dL|8.5-10.5|N|||F|||20231215120000
OBX|4|NM|2951-2^SODIUM^LN||142|mmol/L|136-145|N|||F|||20231215120000
Output: FHIR Bundle
{
"resourceType": "Bundle",
"type": "collection",
"entry": [
{
"resource": {
"resourceType": "DiagnosticReport",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab"
]
},
"status": "final",
"category": [{
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "LAB"
}]
}],
"code": {
"coding": [{
"system": "http://www.ama-assn.org/go/cpt",
"code": "80053",
"display": "Comprehensive Metabolic Panel"
}]
},
"result": [
{"reference": "Observation/obs-glucose"},
{"reference": "Observation/obs-creatinine"},
{"reference": "Observation/obs-calcium"},
{"reference": "Observation/obs-sodium"}
]
}
},
{
"resource": {
"resourceType": "Observation",
"id": "obs-glucose",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"
]
},
"status": "final",
"category": [{
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory"
}]
}],
"code": {
"coding": [{
"system": "http://loinc.org",
"code": "2345-7",
"display": "Glucose"
}]
},
"valueQuantity": {
"value": 105,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
},
"interpretation": [{
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "H",
"display": "High"
}]
}],
"referenceRange": [{
"low": {"value": 70, "unit": "mg/dL"},
"high": {"value": 100, "unit": "mg/dL"}
}]
}
}
]
}
Patient 1
DiagnosticReport 1
Observation 4
Practitioner 1
Provenance 1
X12 5010 Samples
X12 EDI transactions transform into claims, remittance, eligibility, and coverage resources.
Input: X12 835 Remittance
ISA*00* *00* *ZZ*PAYER835 *ZZ*PROVIDER835 *251226*1916*^*00501*582445567*0*T*:~ GS*HP*PAYER835*PROVIDER835*20251226*1916*1354*X*005010X221A1~ ST*835*7873*005010X221A1~ BPR*I*2485.28*C*ACH***CCP*01*******20251226~ TRN*1*TRN620030446*141713280~ N1*PR*Centene*XV*1440118134~ N3*5745 Main Ave~ N4*Georgetown*MN*56257~ REF*EO*141713280~ N1*PE*Family Medicine Associates*XX*1212431962~ N3*250 Valley Ct~ N4*Oxford*CA*92996~ REF*TJ*617443462~ CLP*CLM20251226160897*1*265.09*204.15*60.94*12*PCN523067214*~ NM1*QC*1*Taylor*Jeffrey*B***MI*U364466299~ SVC*HC:99232*125.00*86.25**1~ DTP*472*D8*20251208~ CAS*CO*45*38.75~ SVC*HC:99283*175.00*108.50**1~ DTP*472*D8*20251211~ CAS*CO*45*66.50~ SE*35*7873~ GE*1*1354~ IEA*1*582445567~
Output: FHIR Bundle
{
"resourceType": "Bundle",
"id": "x12-835-remittance",
"type": "collection",
"entry": [
{
"resource": {
"resourceType": "ExplanationOfBenefit",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-explanationofbenefit"
]
},
"status": "active",
"type": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}]
},
"use": "claim",
"patient": {"reference": "Patient/taylor-jeffrey"},
"insurer": {"reference": "Organization/centene"},
"provider": {"reference": "Organization/family-medicine"},
"outcome": "complete",
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99232",
"display": "Subsequent Hospital Care"
}]
},
"servicedDate": "2025-12-08",
"adjudication": [
{
"category": {"coding": [{"code": "submitted"}]},
"amount": {"value": 125.00, "currency": "USD"}
},
{
"category": {"coding": [{"code": "benefit"}]},
"amount": {"value": 86.25, "currency": "USD"}
}
]
}
],
"total": [
{
"category": {"coding": [{"code": "submitted"}]},
"amount": {"value": 265.09, "currency": "USD"}
},
{
"category": {"coding": [{"code": "benefit"}]},
"amount": {"value": 204.15, "currency": "USD"}
}
],
"payment": {
"type": {"coding": [{"code": "complete"}]},
"date": "2025-12-26",
"amount": {"value": 2485.28, "currency": "USD"}
}
}
},
{
"resource": {
"resourceType": "Organization",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"
]
},
"identifier": [{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1440118134"
}],
"name": "Centene",
"address": [{
"line": ["5745 Main Ave"],
"city": "Georgetown",
"state": "MN",
"postalCode": "56257"
}]
}
},
{
"resource": {
"resourceType": "Patient",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
]
},
"identifier": [{
"type": {"coding": [{"code": "MB"}]},
"value": "U364466299"
}],
"name": [{
"family": "Taylor",
"given": ["Jeffrey", "B"]
}]
}
}
]
}
ExplanationOfBenefit 1
Organization 2
Patient 1
Coverage 1
Provenance 1
Input: X12 837P Professional Claim
ISA*00* *00* *ZZ*SENDER837P *ZZ*RECEIVER837P *251226*1916*^*00501*290175496*0*T*:~ GS*HC*SENDER837P*RECEIVER837P*20251226*1916*5508*X*005010X222A1~ ST*837*6090*005010X222A1~ BHT*0019*00*837P6090*20251226*1916*CH~ NM1*41*2*SENDER NAME*****46*SENDER837P~ NM1*40*2*RECEIVER NAME*****46*RECEIVER837P~ HL*1**20*1~ NM1*85*2*Cornerstone Health*****XX*1381427220~ N3*5975 Hill St~ N4*Oakland*NY*13418~ REF*EI*627170101~ HL*2*1*22*0~ SBR*P*01*GRP247469*****MB~ NM1*IL*1*Ramirez*Brian*H***MI*D556373333~ N3*5221 Valley Ct~ N4*Arlington*MI*48210~ DMG*D8*19500131*M~ NM1*PR*2*Cigna*****PI*PAYER931~ CLM*CLM20251226602951*474.10***11:1:1*Y*A*Y*Y~ DTP*472*D8*20251225~ HI*ABK:E11.9*ABF:I25.10*ABF:R10.9*ABF:M54.5~ LX*1~ SV1*HC:99214*148.75*UN*1*11**1~ DTP*472*D8*20251219~ LX*2~ SV1*HC:80053*28.35*UN*1*11**1~ DTP*472*D8*20251129~ SE*32*6090~ GE*1*5508~ IEA*1*290175496~
Output: FHIR Bundle
{
"resourceType": "Bundle",
"id": "x12-837p-claim",
"type": "collection",
"entry": [
{
"resource": {
"resourceType": "Claim",
"meta": {
"profile": [
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Claim-Professional"
]
},
"status": "active",
"type": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}]
},
"use": "claim",
"patient": {"reference": "Patient/ramirez-brian"},
"billablePeriod": {
"start": "2025-12-25",
"end": "2025-12-25"
},
"provider": {"reference": "Organization/cornerstone-health"},
"insurer": {"reference": "Organization/cigna"},
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [{
"system": "http://hl7.org/fhir/sid/icd-10-cm",
"code": "E11.9",
"display": "Type 2 diabetes mellitus without complications"
}]
},
"type": [{"coding": [{"code": "principal"}]}]
},
{
"sequence": 2,
"diagnosisCodeableConcept": {
"coding": [{
"system": "http://hl7.org/fhir/sid/icd-10-cm",
"code": "I25.10",
"display": "Atherosclerotic heart disease"
}]
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99214",
"display": "Office/outpatient visit"
}]
},
"servicedDate": "2025-12-19",
"unitPrice": {"value": 148.75, "currency": "USD"},
"net": {"value": 148.75, "currency": "USD"}
},
{
"sequence": 2,
"productOrService": {
"coding": [{
"system": "http://www.ama-assn.org/go/cpt",
"code": "80053",
"display": "Comprehensive metabolic panel"
}]
},
"servicedDate": "2025-11-29",
"unitPrice": {"value": 28.35, "currency": "USD"}
}
],
"total": {"value": 474.10, "currency": "USD"}
}
},
{
"resource": {
"resourceType": "Patient",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
]
},
"identifier": [{
"type": {"coding": [{"code": "MB"}]},
"value": "D556373333"
}],
"name": [{
"family": "Ramirez",
"given": ["Brian", "H"]
}],
"gender": "male",
"birthDate": "1950-01-31",
"address": [{
"line": ["5221 Valley Ct"],
"city": "Arlington",
"state": "MI",
"postalCode": "48210"
}]
}
}
]
}
Claim 1
Patient 1
Organization 2
Coverage 1
Provenance 1
CMS-0057-F Samples
X12 transactions transformed with CMS-0057-F compliance using Da Vinci PAS, CARIN Blue Button, and PDex Provenance profiles.
Input: X12 278 Prior Authorization
ISA*00* *00* *ZZ*SENDER278 *ZZ*RECEIVER278 *251226*1200*^*00501*000000001*0*T*:~ GS*HI*SENDER278*RECEIVER278*20251226*1200*1*X*005010X217~ ST*278*0001*005010X217~ BHT*0078*11*REF123456*20251226*1200~ HL*1**20*1~ NM1*X3*2*AETNA HEALTH*****PI*12345~ HL*2*1*21*1~ NM1*1P*1*SMITH*JOHN****XX*1234567890~ PRV*PE*PXC*207Q00000X~ HL*3*2*22*1~ TRN*1*PRIOR123456*9012345678~ NM1*IL*1*DOE*JANE****MI*ABC123456~ DMG*D8*19800215*F~ DTP*472*D8*20251226~ UM*HS*I*3~ HCR*A1*AUTH789012~ HI*ABK:M54.5~ HI*ABF:G89.29~ SV1*HC:99213*150.00*UN*1***1~ DTP*472*RD8*20260101-20260131~ SE*18*0001~ GE*1*1~ IEA*1*000000001~
Output: FHIR Bundle (Da Vinci PAS)
{
"resourceType": "Bundle",
"id": "x12-278-prior-auth",
"type": "collection",
"entry": [
{
"resource": {
"resourceType": "Claim",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"
]
},
"status": "active",
"type": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}]
},
"use": "preauthorization",
"patient": {"reference": "Patient/doe-jane"},
"provider": {"reference": "Practitioner/smith-john"},
"insurer": {"reference": "Organization/aetna"},
"priority": {"coding": [{"code": "normal"}]},
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [{
"system": "http://hl7.org/fhir/sid/icd-10-cm",
"code": "M54.5",
"display": "Low back pain"
}]
}
},
{
"sequence": 2,
"diagnosisCodeableConcept": {
"coding": [{
"system": "http://hl7.org/fhir/sid/icd-10-cm",
"code": "G89.29",
"display": "Other chronic pain"
}]
}
}
],
"item": [{
"sequence": 1,
"productOrService": {
"coding": [{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99213",
"display": "Office visit, established patient"
}]
},
"servicedPeriod": {
"start": "2026-01-01",
"end": "2026-01-31"
},
"unitPrice": {"value": 150.00, "currency": "USD"}
}]
}
},
{
"resource": {
"resourceType": "ClaimResponse",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"
]
},
"status": "active",
"type": {"coding": [{"code": "professional"}]},
"use": "preauthorization",
"patient": {"reference": "Patient/doe-jane"},
"outcome": "complete",
"preAuthRef": "AUTH789012"
}
},
{
"resource": {
"resourceType": "Provenance",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
]
},
"recorded": "2025-12-26T12:00:00Z",
"agent": [{
"type": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
"code": "author"
}]
}
}],
"entity": [{
"role": "source",
"what": {
"display": "X12 278 Prior Authorization Request"
},
"extension": [{
"url": "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/ProvenanceSourceFrom",
"valueCodeableConcept": {
"coding": [{
"system": "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/ProvenancePayerDataSource",
"code": "x12278",
"display": "X12 278 Prior Authorization"
}]
}
}]
}]
}
}
]
}
Claim (PAS) 1
ClaimResponse (PAS) 1
Patient 1
Practitioner 1
Organization 1
Provenance (PDex) 1
Input: X12 835 Remittance
ISA*00* *00* *ZZ*PAYER835 *ZZ*PROVIDER835 *251226*1916*^*00501*582445567*0*T*:~ GS*HP*PAYER835*PROVIDER835*20251226*1916*1354*X*005010X221A1~ ST*835*7873*005010X221A1~ BPR*I*2485.28*C*ACH***CCP*01*******20251226~ TRN*1*TRN620030446*141713280~ N1*PR*Centene*XV*1440118134~ N3*5745 Main Ave~ N4*Georgetown*MN*56257~ N1*PE*Family Medicine Associates*XX*1212431962~ CLP*CLM20251226160897*1*265.09*204.15*60.94*12*PCN523067214*~ NM1*QC*1*Taylor*Jeffrey*B***MI*U364466299~ SVC*HC:99232*125.00*86.25**1~ DTP*472*D8*20251208~ CAS*CO*45*38.75~ SVC*HC:99283*175.00*108.50**1~ DTP*472*D8*20251211~ CAS*CO*45*66.50~ SE*18*7873~ GE*1*1354~ IEA*1*582445567~
Output: FHIR Bundle (CARIN Blue Button)
{
"resourceType": "Bundle",
"id": "x12-835-carin",
"type": "collection",
"entry": [
{
"resource": {
"resourceType": "ExplanationOfBenefit",
"meta": {
"profile": [
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"
]
},
"status": "active",
"type": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}]
},
"use": "claim",
"patient": {"reference": "Patient/taylor-jeffrey"},
"billablePeriod": {
"start": "2025-12-08",
"end": "2025-12-11"
},
"insurer": {"reference": "Organization/centene"},
"provider": {"reference": "Organization/family-medicine"},
"outcome": "complete",
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99232",
"display": "Subsequent Hospital Care"
}]
},
"servicedDate": "2025-12-08",
"adjudication": [
{
"category": {
"coding": [{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
"code": "benefitpaymentstatus"
}]
},
"reason": {
"coding": [{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus",
"code": "innetwork"
}]
}
},
{
"category": {"coding": [{"code": "submitted"}]},
"amount": {"value": 125.00, "currency": "USD"}
},
{
"category": {"coding": [{"code": "benefit"}]},
"amount": {"value": 86.25, "currency": "USD"}
}
]
}
],
"total": [
{
"category": {"coding": [{"code": "submitted"}]},
"amount": {"value": 265.09, "currency": "USD"}
},
{
"category": {"coding": [{"code": "benefit"}]},
"amount": {"value": 204.15, "currency": "USD"}
}
],
"payment": {
"date": "2025-12-26",
"amount": {"value": 2485.28, "currency": "USD"}
}
}
},
{
"resource": {
"resourceType": "Provenance",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
]
},
"recorded": "2025-12-26T19:16:00Z",
"entity": [{
"role": "source",
"what": {"display": "X12 835 Remittance Advice"},
"extension": [{
"url": "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/ProvenanceSourceFrom",
"valueCodeableConcept": {
"coding": [{
"system": "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/ProvenancePayerDataSource",
"code": "x12other",
"display": "X12 Other"
}]
}
}]
}]
}
}
]
}
ExplanationOfBenefit (CARIN) 1
Patient 1
Organization 2
Coverage 1
Provenance (PDex) 1
C-CDA Samples
C-CDA R2.1 clinical documents transform into comprehensive bundles with Composition and all clinical sections.
Input: C-CDA CCD (Abbreviated)
<?xml version="1.0" encoding="UTF-8"?> <ClinicalDocument xmlns="urn:hl7-org:v3"> <realmCode code="US"/> <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/> <templateId root="2.16.840.1.113883.10.20.22.1.2" extension="2024-05-01"/> <code code="34133-9" displayName="Summary of Episode Note" codeSystem="2.16.840.1.113883.6.1"/> <title>Continuity of Care Document</title> <effectiveTime value="20230501114559-0500"/> <recordTarget> <patientRole> <id extension="444222222" root="2.16.840.1.113883.4.1"/> <addr use="HP"> <streetAddressLine>2222 Home Street</streetAddressLine> <city>Beaverton</city> <state>MD</state> <postalCode>21014</postalCode> </addr> <patient> <name use="L"> <given>Eve</given> <family>Betterhalf</family> </name> <administrativeGenderCode code="F"/> <birthTime value="19750501"/> </patient> </patientRole> </recordTarget> <!-- Problems Section --> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.5.1"/> <code code="11450-4" codeSystem="2.16.840.1.113883.6.1"/> <title>Problems</title> <entry> <act classCode="ACT"> <entryRelationship> <observation> <code code="64572001" codeSystem="2.16.840.1.113883.6.96" displayName="Condition"/> <value code="J06.9" displayName="Acute URI" codeSystem="2.16.840.1.113883.6.90"/> </observation> </entryRelationship> </act> </entry> </section> </component> <!-- Medications, Allergies, Results sections... --> </ClinicalDocument>
Output: FHIR Bundle
{
"resourceType": "Bundle",
"type": "collection",
"entry": [
{
"resource": {
"resourceType": "Composition",
"language": "en-US",
"identifier": {
"system": "urn:oid:2.16.840.1.113883.19.5.99999.1",
"value": "TT988"
},
"status": "final",
"type": {
"coding": [{
"system": "http://loinc.org",
"code": "34133-9",
"display": "Summary of episode note"
}]
},
"subject": {"reference": "Patient/eve-betterhalf"},
"date": "2023-05-01T11:45:59-05:00",
"title": "Continuity of Care Document",
"section": [
{
"title": "Problems",
"code": {
"coding": [{
"system": "http://loinc.org",
"code": "11450-4",
"display": "Problem List"
}]
},
"entry": [
{"reference": "Condition/acute-uri"},
{"reference": "Condition/immunization-encounter"}
]
},
{
"title": "Medications",
"code": {
"coding": [{
"system": "http://loinc.org",
"code": "10160-0",
"display": "History of Medication Use"
}]
},
"entry": [
{"reference": "MedicationStatement/cyclobenzaprine"},
{"reference": "MedicationStatement/metformin"}
]
},
{
"title": "Allergies",
"code": {
"coding": [{
"system": "http://loinc.org",
"code": "48765-2"
}]
},
"entry": [
{"reference": "AllergyIntolerance/peanut"},
{"reference": "AllergyIntolerance/morphine"},
{"reference": "AllergyIntolerance/tree-nut"}
]
}
]
}
},
{
"resource": {
"resourceType": "Patient",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
]
},
"identifier": [{
"system": "urn:oid:2.16.840.1.113883.4.1",
"value": "444222222"
}],
"name": [{
"use": "official",
"family": "Betterhalf",
"given": ["Eve"]
}],
"gender": "female",
"birthDate": "1975-05-01",
"address": [{
"use": "home",
"line": ["2222 Home Street"],
"city": "Beaverton",
"state": "MD",
"postalCode": "21014"
}]
}
},
{
"resource": {
"resourceType": "Condition",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns"
]
},
"clinicalStatus": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
}]
},
"code": {
"coding": [{
"system": "http://hl7.org/fhir/sid/icd-10-cm",
"code": "J06.9",
"display": "Acute upper respiratory infection, unspecified"
}]
},
"subject": {"reference": "Patient/eve-betterhalf"}
}
},
{
"resource": {
"resourceType": "AllergyIntolerance",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance"
]
},
"clinicalStatus": {
"coding": [{"code": "active"}]
},
"code": {
"coding": [{
"system": "http://snomed.info/sct",
"code": "91935009",
"display": "Allergy to peanuts"
}]
},
"patient": {"reference": "Patient/eve-betterhalf"}
}
}
]
}
Composition 1
Patient 1
Condition 2
MedicationStatement 2
AllergyIntolerance 3
Observation 8
Immunization 2
Provenance 1