{
  "resourceType": "Bundle",
  "id": "15da065c-5b75-4acf-a2ba-1355de821d6e",
  "meta": {
    "versionId": "1",
    "profile": [
      "https://fhir.kbv.de/StructureDefinition/KBV_PR_ERP_Bundle|1.4"
    ]
  },
  "identifier": {
    "system": "https://gematik.de/fhir/erp/NamingSystem/GEM_ERP_NS_PrescriptionId",
    "value": "160.100.000.000.017.88"
  },
  "type": "document",
  "timestamp": "2024-05-20T08:30:00+00:00",
  "entry": [
    {
      "fullUrl": "http://pvs.praxis.local/fhir/Composition/f62c91e7-e280-4d32-961b-b07168ab47d7",
      "resource": {
        "resourceType": "Composition",
        "id": "f62c91e7-e280-4d32-961b-b07168ab47d7",
        "meta": {
          "versionId": "1",
          "profile": [
            "https://fhir.kbv.de/StructureDefinition/KBV_PR_ERP_Composition|1.4"
          ]
        },
        "extension": [
          {
            "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_Legal_basis",
            "valueCoding": {
              "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_STATUSKENNZEICHEN",
              "code": "00"
            }
          }
        ],
        "status": "final",
        "type": {
          "coding": [
            {
              "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_FORMULAR_ART",
              "code": "e16A"
            }
          ]
        },
        "subject": {
          "reference": "Patient/ce4104af-b86b-4664-afee-1b5fc3ac8acf"
        },
        "date": "2024-05-20T08:00:00Z",
        "author": [
          {
            "reference": "Practitioner/667ffd79-42a3-4002-b7ca-6b9098f20ccb",
            "type": "Practitioner"
          },
          {
            "type": "Device",
            "identifier": {
              "system": "https://fhir.kbv.de/NamingSystem/KBV_NS_FOR_Pruefnummer",
              "value": "Y/400/2107/36/999"
            }
          }
        ],
        "title": "elektronische Arzneimittelverordnung",
        "custodian": {
          "reference": "Organization/5d3f4ac0-2b44-4d48-b363-e63efa72973b"
        },
        "section": [
          {
            "code": {
              "coding": [
                {
                  "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_ERP_Section_Type",
                  "code": "Prescription"
                }
              ]
            },
            "entry": [
              {
                "reference": "MedicationRequest/1e923204-6866-4030-a460-2ce5bd9db26b"
              }
            ]
          },
          {
            "code": {
              "coding": [
                {
                  "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_ERP_Section_Type",
                  "code": "Coverage"
                }
              ]
            },
            "entry": [
              {
                "reference": "Coverage/da80211e-61ee-458e-a651-87370b6ec30c"
              }
            ]
          }
        ]
      }
    },
    {
      "fullUrl": "http://pvs.praxis.local/fhir/MedicationRequest/1e923204-6866-4030-a460-2ce5bd9db26b",
      "resource": {
        "resourceType": "MedicationRequest",
        "id": "1e923204-6866-4030-a460-2ce5bd9db26b",
        "meta": {
          "versionId": "1",
          "profile": [
            "https://fhir.kbv.de/StructureDefinition/KBV_PR_ERP_Prescription|1.4"
          ]
        },
        "extension": [
          {
            "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_StatusCoPayment",
            "valueCoding": {
              "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_FOR_StatusCoPayment",
              "code": "0"
            }
          },
          {
            "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_ERP_EmergencyServicesFee",
            "valueBoolean": false
          },
          {
            "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_SER",
            "valueBoolean": false
          },
          {
            "extension": [
              {
                "url": "Kennzeichen",
                "valueBoolean": true
              },
              {
                "url": "Nummerierung",
                "valueRatio": {
                  "numerator": {
                    "value": 4
                  },
                  "denominator": {
                    "value": 4
                  }
                }
              },
              {
                "url": "Zeitraum",
                "valuePeriod": {
                  "start": "2024-12-01"
                }
              },
              {
                "url": "ID",
                "valueIdentifier": {
                  "system": "urn:ietf:rfc:3986",
                  "value": "urn:uuid:24e2e10d-e962-4d1c-be4f-8760e690a5f0"
                }
              }
            ],
            "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_ERP_Multiple_Prescription"
          },
          {
            "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_ERP_DosageFlag",
            "valueBoolean": false
          }
        ],
        "status": "active",
        "intent": "order",
        "medicationReference": {
          "reference": "Medication/07c10a67-2ece-4d5d-9394-633e07c9656d"
        },
        "subject": {
          "reference": "Patient/ce4104af-b86b-4664-afee-1b5fc3ac8acf"
        },
        "authoredOn": "2024-05-20",
        "requester": {
          "reference": "Practitioner/667ffd79-42a3-4002-b7ca-6b9098f20ccb"
        },
        "insurance": [
          {
            "reference": "Coverage/da80211e-61ee-458e-a651-87370b6ec30c"
          }
        ],
        "dispenseRequest": {
          "quantity": {
            "value": 1,
            "unit": "Packung"
          }
        },
        "substitution": {
          "allowedBoolean": false
        }
      }
    },
    {
      "fullUrl": "http://pvs.praxis.local/fhir/Medication/07c10a67-2ece-4d5d-9394-633e07c9656d",
      "resource": {
        "resourceType": "Medication",
        "id": "07c10a67-2ece-4d5d-9394-633e07c9656d",
        "meta": {
          "versionId": "1",
          "profile": [
            "https://fhir.kbv.de/StructureDefinition/KBV_PR_ERP_Medication_PZN|1.4"
          ]
        },
        "extension": [
          {
            "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_Base_Medication_Type",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "version": "http://snomed.info/sct/11000274103/version/20240515",
                  "code": "763158003",
                  "display": "Medicinal product (product)"
                }
              ]
            }
          },
          {
            "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_ERP_Medication_Category",
            "valueCoding": {
              "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_ERP_Medication_Category",
              "code": "00"
            }
          },
          {
            "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_ERP_Medication_Vaccine",
            "valueBoolean": false
          },
          {
            "url": "http://fhir.de/StructureDefinition/normgroesse",
            "valueCode": "N3"
          }
        ],
        "code": {
          "coding": [
            {
              "system": "http://fhir.de/CodeSystem/ifa/pzn",
              "code": "02532741"
            }
          ],
          "text": "L-Thyroxin Henning 75 100 Tbl. N3"
        },
        "form": {
          "coding": [
            {
              "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM",
              "code": "TAB"
            }
          ]
        },
        "ingredient": [
          {
            "itemCodeableConcept": {
              "text": "Levothyroxin"
            },
            "strength": {
              "numerator": {
                "value": 72.9,
                "unit": "µg"
              },
              "denominator": {
                "value": 1,
                "unit": "Stück"
              }
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://pvs.praxis.local/fhir/Patient/ce4104af-b86b-4664-afee-1b5fc3ac8acf",
      "resource": {
        "resourceType": "Patient",
        "id": "ce4104af-b86b-4664-afee-1b5fc3ac8acf",
        "meta": {
          "versionId": "1",
          "profile": [
            "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Patient|1.3"
          ]
        },
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://fhir.de/CodeSystem/identifier-type-de-basis",
                  "code": "KVZ10"
                }
              ]
            },
            "system": "http://fhir.de/sid/gkv/kvid-10",
            "value": "K030182229"
          }
        ],
        "name": [
          {
            "use": "official",
            "family": "Kluge",
            "_family": {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/humanname-own-name",
                  "valueString": "Kluge"
                }
              ]
            },
            "given": [
              "Eva"
            ],
            "prefix": [
              "Prof. Dr. Dr. med"
            ],
            "_prefix": [
              {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier",
                    "valueCode": "AC"
                  }
                ]
              }
            ]
          }
        ],
        "birthDate": "1982-01-03",
        "address": [
          {
            "type": "both",
            "line": [
              "Pflasterhofweg 111B"
            ],
            "_line": [
              {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber",
                    "valueString": "111B"
                  },
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName",
                    "valueString": "Pflasterhofweg"
                  }
                ]
              }
            ],
            "city": "Köln",
            "postalCode": "50999",
            "country": "D"
          }
        ]
      }
    },
    {
      "fullUrl": "http://pvs.praxis.local/fhir/Practitioner/667ffd79-42a3-4002-b7ca-6b9098f20ccb",
      "resource": {
        "resourceType": "Practitioner",
        "id": "667ffd79-42a3-4002-b7ca-6b9098f20ccb",
        "meta": {
          "versionId": "1",
          "profile": [
            "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Practitioner|1.3"
          ]
        },
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "LANR"
                }
              ]
            },
            "system": "https://fhir.kbv.de/NamingSystem/KBV_NS_Base_ANR",
            "value": "987654423"
          }
        ],
        "name": [
          {
            "use": "official",
            "family": "Schneider",
            "_family": {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/humanname-own-name",
                  "valueString": "Schneider"
                }
              ]
            },
            "given": [
              "Emma"
            ],
            "prefix": [
              "Dr. med."
            ],
            "_prefix": [
              {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier",
                    "valueCode": "AC"
                  }
                ]
              }
            ]
          }
        ],
        "qualification": [
          {
            "code": {
              "coding": [
                {
                  "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_FOR_Qualification_Type",
                  "code": "00"
                }
              ]
            }
          },
          {
            "code": {
              "coding": [
                {
                  "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_FOR_Berufsbezeichnung",
                  "code": "Berufsbezeichnung"
                }
              ],
              "text": "Fachärztin für Innere Medizin"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://pvs.praxis.local/fhir/Organization/5d3f4ac0-2b44-4d48-b363-e63efa72973b",
      "resource": {
        "resourceType": "Organization",
        "id": "5d3f4ac0-2b44-4d48-b363-e63efa72973b",
        "meta": {
          "versionId": "1",
          "profile": [
            "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Organization|1.3"
          ]
        },
        "identifier": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "BSNR"
                }
              ]
            },
            "system": "https://fhir.kbv.de/NamingSystem/KBV_NS_Base_BSNR",
            "value": "721111100"
          }
        ],
        "name": "MVZ",
        "telecom": [
          {
            "system": "phone",
            "value": "0301234567"
          },
          {
            "system": "fax",
            "value": "030123456789"
          },
          {
            "system": "email",
            "value": "mvz@e-mail.de"
          }
        ],
        "address": [
          {
            "type": "both",
            "line": [
              "Herbert-Lewin-Platz 2"
            ],
            "_line": [
              {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber",
                    "valueString": "2"
                  },
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName",
                    "valueString": "Herbert-Lewin-Platz"
                  }
                ]
              }
            ],
            "city": "Berlin",
            "postalCode": "10623",
            "country": "D"
          }
        ]
      }
    },
    {
      "fullUrl": "http://pvs.praxis.local/fhir/Coverage/da80211e-61ee-458e-a651-87370b6ec30c",
      "resource": {
        "resourceType": "Coverage",
        "id": "da80211e-61ee-458e-a651-87370b6ec30c",
        "meta": {
          "versionId": "1",
          "profile": [
            "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Coverage|1.3"
          ]
        },
        "extension": [
          {
            "url": "http://fhir.de/StructureDefinition/gkv/besondere-personengruppe",
            "valueCoding": {
              "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_PERSONENGRUPPE",
              "code": "00"
            }
          },
          {
            "url": "http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen",
            "valueCoding": {
              "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DMP",
              "code": "00"
            }
          },
          {
            "url": "http://fhir.de/StructureDefinition/gkv/wop",
            "valueCoding": {
              "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_ITA_WOP",
              "code": "38"
            }
          },
          {
            "url": "http://fhir.de/StructureDefinition/gkv/versichertenart",
            "valueCoding": {
              "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_VERSICHERTENSTATUS",
              "code": "3"
            }
          }
        ],
        "status": "active",
        "type": {
          "coding": [
            {
              "system": "http://fhir.de/CodeSystem/versicherungsart-de-basis",
              "code": "GKV"
            }
          ]
        },
        "beneficiary": {
          "reference": "Patient/ce4104af-b86b-4664-afee-1b5fc3ac8acf"
        },
        "payor": [
          {
            "identifier": {
              "system": "http://fhir.de/sid/arge-ik/iknr",
              "value": "109777509"
            },
            "display": "Techniker Krankenkasse"
          }
        ]
      }
    }
  ]
}