Transfer of Care R4 Hackathon Implementation Guide

This guidance is under active development by NHS England and content may be added or updated on a regular basis.

Trish Example

Trish is a 34 year old office worker who has had asthma since she was a child. Her asthma can be quite brittle and she often requires oral steroid doses and hospital admissions. She also developed epilepsy in her late teens. This has been difficult to control but she has been well for some time now on Epilim.

Trish’s asthma became suddenly considerably worse and she was admitted to hospital. She was discharged again after 5 days with her medication unchanged apart from being started on an antibiotic and oral steroids.

On admission

  • Flixotide 100micrograms/dose Accuhaler (GlaxoSmithKline UK Ltd) 2 doses to be inhaled twice daily.
  • Ventolin 100micrograms/dose Evohaler (GlaxoSmithKline UK Ltd). 2 doses four times daily and when required for wheezing.
  • Epilim 200mg in the morning and 400mg at night. Epilim 200 gastro-resistant tablets (Sanofi). One tablet in the morning and two at night.
  • Microgynon 30 tablets (Bayer Plc) to be taken as directed

On discharge

  • Flixotide 100micrograms/dose Accuhaler (GlaxoSmithKline UK Ltd) 2 doses to be inhaled twice daily.
  • Ventolin 100micrograms/dose Evohaler (GlaxoSmithKline UK Ltd). Inhale - 2 doses - four times daily and when required for wheezing.
  • Epilim- oral- 200mg in the morning and 400mg at night. Epilim 200 gastro-resistant tablets (Sanofi). One tablet in the morning and two at night.
  • Amoxicillin 500mg orally three times daily for 5 days.
  • Prednisolone – oral - 30mg once daily for 2 days. Then discontinue.
  • Microgynon 30 tablets (Bayer Plc) – oral - follow the directions

The Inpatient Stay

The Inpatient stay is carried in the UKCore-Encounter profiled resource

Named Participants

Named Organisations

Example Instance of Scenario

{
    "resourceType": "Bundle",
    "id": "31585c11-80fa-411a-bedf-b99448550c2a",
    "meta": {
        "lastUpdated": "2023-01-27T16:17:00+00:00",
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle"
        ]
    },
    "identifier": {
        "system": "https://tools.ietf.org/html/rfc4122",
        "value": "95997574-b354-4d07-8e15-94d417abb658"
    },
    "type": "document",
    "timestamp": "2023-01-27T16:17:00Z",
    "entry":  [
        {
            "fullUrl": "urn:uuid:4f589fab-2c7b-4865-ba90-deb3d6158e3d",
            "resource": {
                "resourceType": "Composition",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Composition"
                    ]
                },
                "extension":  [
                    {
                        "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-CareSettingType",
                        "valueCodeableConcept": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "789718008",
                                    "display": "Cardiology service"
                                }
                            ]
                        }
                    }
                ],
                "status": "final",
                "type": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "373942005",
                            "display": "Discharge summary"
                        }
                    ]
                },
                "subject": {
                    "reference": "urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6"
                },
                "encounter": {
                    "reference": "urn:uuid:7eafed78-3e81-4e15-85c6-23485fd2b19d"
                },
                "date": "2023-01-27T15:39:00+00:00",
                "author":  [
                    {
                        "reference": "urn:uuid:fb5cf63f-02c7-49f2-9090-831d4846840f"
                    }
                ],
                "title": "Cardiology Service Discharge Summary",
                "custodian": {
                    "reference": "urn:uuid:6ab7066c-b2bf-4543-9e86-dbf757e0dc4a"
                },
                "section":  [
                    {
                        "title": "Admission details",
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                                    "code": "admission-details",
                                    "display": "Admission details"
                                }
                            ]
                        },
                        "text": {
                            "status": "extensions",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Reason for admission</th><td>Severe asthma attack</td></tr><tr><th>Admission method</th><td>Accident and emergency or dental casualty department of the Health Care Provider</td></tr><tr><th>Source of admission</th><td>Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes Patients with no fixed abode.</td></tr><tr><th>Date/time of admission</th><td>27-Jan-2023 15:39</td></tr></tbody></table></div>"
                        },
                        "entry":  [
                            {
                                "reference": "urn:uuid:7eafed78-3e81-4e15-85c6-23485fd2b19d"
                            }
                        ]
                    },
                    {
                        "title": "Clinical summary",
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                                    "code": "clinical-summary",
                                    "display": "Clinical summary"
                                }
                            ]
                        },
                        "text": {
                            "status": "additional",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Clinical Summary</th></tr><tr><td><p>A 34 year old office worker who has had asthma since she was a child.</p><p>Her asthma can be quite brittle and she often requires oral steroid doses and hospital admissions.</p><p>She also developed epilepsy in her late teens.</p><p>This has been difficult to control but she has been well for some time now on Epilim.</p><p>Asthma became suddenly considerably worse and she was admitted to hospital.</p><p>Discharged after 5 days with medication unchanged apart from being started on an antibiotic and oral steroids.</p></td></tr></tbody></table></div>"
                        }
                    },
                    {
                        "title": "Diagnoses",
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                                    "code": "diagnoses",
                                    "display": "Diagnoses"
                                }
                            ]
                        },
                        "text": {
                            "status": "additional",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Diagnosis name</th><td>Asthma</td></tr><tr><th>Diagnosis name</th><td>Epilepsy</td></tr></tbody></table></div>"
                        },
                        "entry":  [
                            {
                                "reference": "urn:uuid:86806e4c-1768-404a-8725-48a45f27d293"
                            }
                        ]
                    },
                    {
                        "title": "Discharge details",
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                                    "code": "discharge-details",
                                    "display": "Discharge details"
                                }
                            ]
                        },
                        "text": {
                            "status": "additional",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Discharging consultant</th><td><p>Prefix: Dr</p><p>Given Name: Paul</p><p>Family Name: Rastall</p></td></tr><tr><th>Discharge location</th><td><p>Name: Cramer ward</p><p>Identifier: RR8CRAM</p></td></tr><tr><th>Date/time of discharge</th><td>27-Jan-2023 16:17</td></tr><tr><th>Discharge method</th><td>Patient discharged on clinical advice or with clinical consent</td></tr><tr><th>Discharge type</th><td>Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes Patients with no fixed abode.</td></tr></tbody></table></div>"
                        },
                        "entry":  [
                            {
                                "reference": "urn:uuid:7eafed78-3e81-4e15-85c6-23485fd2b19d"
                            },
                            {
                                "reference": "urn:uuid:fb5cf63f-02c7-49f2-9090-831d4846840f"
                            }
                        ]
                    },
                    {
                        "title": "Distribution list",
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                                    "code": "distribution-list",
                                    "display": "Distribution list"
                                }
                            ]
                        },
                        "text": {
                            "status": "generated",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Name</th><td><p>Prefix: Mrs</p><p>Given Name: Angela</p><p>Family Name: Jones</p></td></tr><tr><th>Role</th><td>Community Nurse</td></tr><tr><th>Organisation name</th><td>Leeds Community Healthcare NHS Trust</td></tr></tbody></table><table width=\"100%\"><tbody><tr><th>Name</th><td><p>Prefix: Dr</p><p>Given Name: John</p><p>Family Name: Lorenzo</p></td></tr><tr><th>Role</th><td>General Medical Practitioner</td></tr><tr><th>Organisation name</th><td>MGP Medical Centre</td></tr></tbody></table></div>"
                        },
                        "entry":  [
                            {
                                "reference": "urn:uuid:7d416775-8532-40c2-9b5a-e263137db470"
                            },
                            {
                                "reference": "urn:uuid:0a2171fa-8d4d-4f0d-80b9-db332fdce85e"
                            }
                        ]
                    },
                    {
                        "title": "GP practice",
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                                    "code": "general-practitioner-practice",
                                    "display": "GP practice"
                                }
                            ]
                        },
                        "text": {
                            "status": "additional",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>GP name</th><td><p>Prefix: Dr</p><p>Given Name: John</p><p>Family Name: Lorenzo</p></td></tr><tr><th>GP practice details</th><td><p>Name: MGP Medical Centre</p><p>Address:</p><p>Address Line: 1 MGP House, Overtown</p><p>City: Leeds</p><p>Post Code: LS21 7PA</p></td></tr></tbody></table></div>"
                        },
                        "entry":  [
                            {
                                "reference": "urn:uuid:12738016-98c2-49ab-b032-5558b3978993"
                            }
                        ]
                    },
                    {
                        "title": "Medications and medical devices",
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                                    "code": "medications-and-medical-devices",
                                    "display": "Medications and medical devices"
                                }
                            ]
                        },
                        "text": {
                            "status": "extensions",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><!-- Medication 1 --><tbody><tr><th>Medication name</th><td>Flixotide 100micrograms/dose Accuhaler (GlaxoSmithKline UK Ltd)</td></tr><tr><th>Form</th><td>Inhaler</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>2 doses to be inhaled twice daily.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width=\"100%\"><!-- Medication 2 --><tbody><tr><th>Medication name</th><td>Salbutamol 100micrograms/dose inhaler</td></tr><tr><th>Form</th><td>Inhaler</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>Inhale 2 doses - four times daily and when required for wheezing</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width=\"100%\"><!-- Medication 3 --><tbody><tr><th>Medication name</th><td>Epilim- oral- 200mg </td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>One tablet in the morning and two at night.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width=\"100%\"><!-- Medication 4 --><tbody><tr><th>Medication name</th><td>Amoxicillin 500mg </td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>three times daily for 5 days</td></tr><tr><th>Status</th><td>Added</td></tr></tbody></table><table width=\"100%\"><!-- Medication 5 --><tbody><tr><th>Medication name</th><td>Prednisolone</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>30mg once daily for 2 days. Then discontinue</td></tr><tr><th>Status</th><td>Added</td></tr></tbody></table><table width=\"100%\"><!-- Medication 6 --><tbody><tr><th>Medication name</th><td>Microgynon </td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>follow the directions.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table></div>"
                        },
                        "entry":  [
                            {
                                "reference": "urn:uuid:19c5621a-7c47-444a-9a06-82f11144640a"
                            }
                        ]
                    },
                    {
                        "title": "Patient demographics",
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                                    "code": "patient-demographics",
                                    "display": "Patient demographics"
                                }
                            ]
                        },
                        "text": {
                            "status": "additional",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Patient name</th><td><p>Prefix: Miss</p><p>Given Name: Trish</p><p>Family Name: Trivett</p></td></tr><tr><th>Date of birth</th><td>1 January 1989</td></tr><tr><th>Gender</th><td>Female</td></tr><tr><th>NHS number</th><td>9449307458</td></tr><tr><th>Patient address</th><td><p>Address Line: 21, Grove Street, Overtown</p><p>City: Leeds</p><p>Post Code: LS21 1PF</p></td></tr></tbody></table></div>"
                        },
                        "entry":  [
                            {
                                "reference": "urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6"
                            }
                        ]
                    },
                    {
                        "title": "Person completing record",
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                                    "code": "person-completing-record",
                                    "display": "Person completing record"
                                }
                            ]
                        },
                        "text": {
                            "status": "additional",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Name</th><td><p>Prefix: Dr</p><p>Given Name: Paul</p><p>Family Name: Rastall</p></td></tr><tr><th>Role</th><td>Consultant</td></tr><tr><th>Professional identifier</th><td>GMC: 6122477</td></tr><tr><th>Date and time completed</th><td>27-Jan-2023 16:17</td></tr><tr><th>Contact details</th><td>Phone: 0113 6323200 (Work)</td></tr><tr><th>Organisation</th><td><p>Name: Leeds Teaching Hospitals NHS Trust,</p><p>Address Line: St James's University Hospital, Beckett Street</p><p>City: Leeds</p><p>Post Code: LS9 7TF</p></td></tr></tbody></table></div>"
                        },
                        "entry":  [
                            {
                                "reference": "urn:uuid:fb5cf63f-02c7-49f2-9090-831d4846840f"
                            }
                        ]
                    },
                    {
                        "title": "Plan and requested actions",
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                                    "code": "plan-and-requested-actions",
                                    "display": "Plan and requested actions"
                                }
                            ]
                        },
                        "text": {
                            "status": "additional",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Actions for healthcare professionals</th><td>\n                      GP please continue secondary preventative medication. \n                                 \n                      <p>Status: Requested</p></td></tr></tbody></table></div>"
                        }
                    },
                    {
                        "title": "Referrer details",
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                                    "code": "referrer-details",
                                    "display": "Referrer details"
                                }
                            ]
                        },
                        "text": {
                            "status": "generated",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Referrer details</th><td><p>Name:</p><p>Prefix: Dr.</p><p>Given name: Amanda</p><p>Family name: Smith</p><p>Role: Specialist Registrar</p><p>Tel: 0113 6323222 (work)</p><p>Organisation</p><p>Name: St. James's University Hospital Accident and Emergency Department</p><p>Address Line: St James's University Hospital, Beckett Street</p><p>City: Leeds</p><p>Post Code: LS9 7TF</p></td></tr></tbody></table></div>"
                        },
                        "entry":  [
                            {
                                "reference": "urn:uuid:9f81b69d-2a50-4514-abee-875e1f749fb8"
                            },
                            {
                                "reference": "urn:uuid:94a1c11e-0950-4af5-84cf-c06a8d4d1c98"
                            }
                        ]
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:7eafed78-3e81-4e15-85c6-23485fd2b19d",
            "resource": {
                "resourceType": "Encounter",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter"
                    ]
                },
                "extension":  [
                    {
                        "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AdmissionMethod",
                        "valueCodeableConcept": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-AdmissionMethodEngland",
                                    "code": "21",
                                    "display": "Accident and emergency or dental casualty department of the Health Care Provider"
                                }
                            ]
                        }
                    }
                ],
                "status": "finished",
                "class": {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                    "code": "IMP",
                    "display": "inpatient encounter"
                },
                "type":  [
                    {
                        "coding":  [
                            {
                                "system": "http://snomed.info/sct",
                                "code": "185212007",
                                "display": "Seen in hospital ward"
                            }
                        ]
                    }
                ],
                "subject": {
                    "reference": "urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6"
                },
                "participant":  [
                    {
                        "type":  [
                            {
                                "coding":  [
                                    {
                                        "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                                        "code": "DIS",
                                        "display": "discharger"
                                    }
                                ]
                            }
                        ],
                        "individual": {
                            "reference": "urn:uuid:fb5cf63f-02c7-49f2-9090-831d4846840f"
                        }
                    }
                ],
                "period": {
                    "start": "2015-02-12T09:00:00+00:00",
                    "end": "2015-02-16T15:00:00+00:00"
                },
                "reasonCode":  [
                    {
                        "coding":  [
                            {
                                "system": "http://snomed.info/sct",
                                "code": "425419005",
                                "display": "ECG: inferior ischaemia"
                            }
                        ]
                    }
                ],
                "hospitalization": {
                    "admitSource": {
                        "coding":  [
                            {
                                "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-SourceOfAdmissionEngland",
                                "code": "51",
                                "display": "NHS other Hospital Provider - Ward for general Patients or the younger physically disabled or A and E department"
                            }
                        ]
                    },
                    "dischargeDisposition": {
                        "coding":  [
                            {
                                "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-DischargeDestinationEngland",
                                "code": "19",
                                "display": "Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes Patients with no fixed abode."
                            }
                        ]
                    }
                },
                "location":  [
                    {
                        "location": {
                            "reference": "urn:uuid:f79fe55e-2a96-47a4-b673-dd06d36b0977"
                        },
                        "period": {
                            "end": "2023-01-27T16:13:00+00:00"
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:19c5621a-7c47-444a-9a06-82f11144640a",
            "resource": {
                "resourceType": "List",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-List"
                    ]
                },
                "status": "current",
                "mode": "snapshot",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "1102411000000102",
                            "display": "Active medications"
                        }
                    ]
                },
                "subject": {
                    "reference": "urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6"
                },
                "encounter": {
                    "reference": "urn:uuid:7eafed78-3e81-4e15-85c6-23485fd2b19d"
                },
                "source": {
                    "reference": "urn:uuid:fb5cf63f-02c7-49f2-9090-831d4846840f"
                },
                "entry":  [
                    {
                        "item": {
                            "reference": "urn:uuid:90d9719f-aba0-4b48-b7d0-e88c924d88fd"
                        }
                    },
                    {
                        "item": {
                            "reference": "urn:uuid:e3825409-b3d6-40f2-a82d-3d9c0813cb43"
                        }
                    },
                    {
                        "item": {
                            "reference": "urn:uuid:955baf08-e23d-44bd-9c1b-ca48ce736339"
                        }
                    },
                    {
                        "item": {
                            "reference": "urn:uuid:6b4c7b3e-7421-4754-81c1-9f59498d2879"
                        }
                    },
                    {
                        "item": {
                            "reference": "urn:uuid:7273fbc4-a4ab-40e6-ad17-90b5ccd47938"
                        }
                    },
                    {
                        "item": {
                            "reference": "urn:uuid:ac1638f3-9f7f-485c-8769-25de945b7d69"
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:90d9719f-aba0-4b48-b7d0-e88c924d88fd",
            "resource": {
                "resourceType": "MedicationStatement",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationStatement"
                    ]
                },
                "status": "active",
                "medicationReference": {
                    "reference": "urn:uuid:8a58edeb-f535-441c-891d-d333b999ccf3"
                },
                "subject": {
                    "reference": "urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6"
                },
                "dosage":  [
                    {
                        "text": "2 doses to be inhaled twice daily",
                        "timing": {
                            "repeat": {
                                "frequency": 2,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "Oral"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 2,
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            "fullUrl": "urn:uuid:12738016-98c2-49ab-b032-5558b3978993",
            "resource": {
                "resourceType": "Organization",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
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                },
                "identifier":  [
                    {
                        "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                        "value": "GP123456"
                    }
                ],
                "name": "MGP Medical Centre",
                "address":  [
                    {
                        "line":  [
                            "1 MGP House, Overtown"
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                        "city": "Leeds",
                        "postalCode": "LS21 7PA"
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                ]
            }
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        {
            "fullUrl": "urn:uuid:6ab7066c-b2bf-4543-9e86-dbf757e0dc4a",
            "resource": {
                "resourceType": "Organization",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
                    ]
                },
                "identifier":  [
                    {
                        "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                        "value": "RR8"
                    }
                ],
                "name": "Leeds Teaching Hospitals NHS Trust",
                "address":  [
                    {
                        "line":  [
                            "St James's University Hospital, Beckett Street"
                        ],
                        "city": "Leeds",
                        "postalCode": "LS9 7TF"
                    }
                ]
            }
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        {
            "fullUrl": "urn:uuid:484a8aa6-7b70-49ae-a638-1784a4744ea3",
            "resource": {
                "resourceType": "Organization",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
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                },
                "identifier":  [
                    {
                        "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                        "value": "RY6"
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                ],
                "name": "Leeds Community Healthcare NHS Trust"
            }
        },
        {
            "fullUrl": "urn:uuid:94a1c11e-0950-4af5-84cf-c06a8d4d1c98",
            "resource": {
                "resourceType": "Organization",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
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                },
                "name": "St. James's University Hospital Accident and Emergency Department",
                "address":  [
                    {
                        "line":  [
                            "St James's University Hospital, Beckett Street"
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                        "city": "Leeds",
                        "postalCode": "LS9 7TF"
                    }
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        {
            "fullUrl": "urn:uuid:f79fe55e-2a96-47a4-b673-dd06d36b0977",
            "resource": {
                "resourceType": "Location",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Location"
                    ]
                },
                "identifier":  [
                    {
                        "system": "https://fhir.nhs.uk/Id/local-location-identifier",
                        "value": "RR8CRAM"
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                ],
                "name": "Cramer Ward",
                "managingOrganization": {
                    "reference": "urn:uuid:6ab7066c-b2bf-4543-9e86-dbf757e0dc4a"
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}
<Bundle xmlns="http://hl7.org/fhir">
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        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle" />
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    <identifier>
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        <value value="95997574-b354-4d07-8e15-94d417abb658" />
    </identifier>
    <type value="document" />
    <timestamp value="2023-01-27T16:17:00Z" />
    <entry>
        <fullUrl value="urn:uuid:4f589fab-2c7b-4865-ba90-deb3d6158e3d" />
        <resource>
            <Composition>
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Composition" />
                </meta>
                <extension url="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-CareSettingType">
                    <valueCodeableConcept>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="789718008" />
                            <display value="Cardiology service" />
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                    </valueCodeableConcept>
                </extension>
                <status value="final" />
                <type>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="373942005" />
                        <display value="Discharge summary" />
                    </coding>
                </type>
                <subject>
                    <reference value="urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6" />
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                <date value="2023-01-27T15:39:00+00:00" />
                <author>
                    <reference value="urn:uuid:fb5cf63f-02c7-49f2-9090-831d4846840f" />
                </author>
                <title value="Cardiology Service Discharge Summary" />
                <custodian>
                    <reference value="urn:uuid:6ab7066c-b2bf-4543-9e86-dbf757e0dc4a" />
                </custodian>
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                    <title value="Admission details" />
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                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                            <code value="admission-details" />
                            <display value="Admission details" />
                        </coding>
                    </code>
                    <text>
                        <status value="extensions" />
                        <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Reason for admission</th><td>Severe asthma attack</td></tr><tr><th>Admission method</th><td>Accident and emergency or dental casualty department of the Health Care Provider</td></tr><tr><th>Source of admission</th><td>Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes Patients with no fixed abode.</td></tr><tr><th>Date/time of admission</th><td>27-Jan-2023 15:39</td></tr></tbody></table></div>
                    </text>
                    <entry>
                        <reference value="urn:uuid:7eafed78-3e81-4e15-85c6-23485fd2b19d" />
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                <section>
                    <title value="Clinical summary" />
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                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                            <code value="clinical-summary" />
                            <display value="Clinical summary" />
                        </coding>
                    </code>
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                        <status value="additional" />
                        <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Clinical Summary</th></tr><tr><td><p>A 34 year old office worker who has had asthma since she was a child.</p><p>Her asthma can be quite brittle and she often requires oral steroid doses and hospital admissions.</p><p>She also developed epilepsy in her late teens.</p><p>This has been difficult to control but she has been well for some time now on Epilim.</p><p>Asthma became suddenly considerably worse and she was admitted to hospital.</p><p>Discharged after 5 days with medication unchanged apart from being started on an antibiotic and oral steroids.</p></td></tr></tbody></table></div>
                    </text>
                </section>
                <section>
                    <title value="Diagnoses" />
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                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                            <code value="diagnoses" />
                            <display value="Diagnoses" />
                        </coding>
                    </code>
                    <text>
                        <status value="additional" />
                        <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Diagnosis name</th><td>Asthma</td></tr><tr><th>Diagnosis name</th><td>Epilepsy</td></tr></tbody></table></div>
                    </text>
                    <entry>
                        <reference value="urn:uuid:86806e4c-1768-404a-8725-48a45f27d293" />
                    </entry>
                </section>
                <section>
                    <title value="Discharge details" />
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                            <code value="discharge-details" />
                            <display value="Discharge details" />
                        </coding>
                    </code>
                    <text>
                        <status value="additional" />
                        <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Discharging consultant</th><td><p>Prefix: Dr</p><p>Given Name: Paul</p><p>Family Name: Rastall</p></td></tr><tr><th>Discharge location</th><td><p>Name: Cramer ward</p><p>Identifier: RR8CRAM</p></td></tr><tr><th>Date/time of discharge</th><td>27-Jan-2023 16:17</td></tr><tr><th>Discharge method</th><td>Patient discharged on clinical advice or with clinical consent</td></tr><tr><th>Discharge type</th><td>Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes Patients with no fixed abode.</td></tr></tbody></table></div>
                    </text>
                    <entry>
                        <reference value="urn:uuid:7eafed78-3e81-4e15-85c6-23485fd2b19d" />
                    </entry>
                    <entry>
                        <reference value="urn:uuid:fb5cf63f-02c7-49f2-9090-831d4846840f" />
                    </entry>
                </section>
                <section>
                    <title value="Distribution list" />
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                            <code value="distribution-list" />
                            <display value="Distribution list" />
                        </coding>
                    </code>
                    <text>
                        <status value="generated" />
                        <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Name</th><td><p>Prefix: Mrs</p><p>Given Name: Angela</p><p>Family Name: Jones</p></td></tr><tr><th>Role</th><td>Community Nurse</td></tr><tr><th>Organisation name</th><td>Leeds Community Healthcare NHS Trust</td></tr></tbody></table><table width="100%"><tbody><tr><th>Name</th><td><p>Prefix: Dr</p><p>Given Name: John</p><p>Family Name: Lorenzo</p></td></tr><tr><th>Role</th><td>General Medical Practitioner</td></tr><tr><th>Organisation name</th><td>MGP Medical Centre</td></tr></tbody></table></div>
                    </text>
                    <entry>
                        <reference value="urn:uuid:7d416775-8532-40c2-9b5a-e263137db470" />
                    </entry>
                    <entry>
                        <reference value="urn:uuid:0a2171fa-8d4d-4f0d-80b9-db332fdce85e" />
                    </entry>
                </section>
                <section>
                    <title value="GP practice" />
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                            <code value="general-practitioner-practice" />
                            <display value="GP practice" />
                        </coding>
                    </code>
                    <text>
                        <status value="additional" />
                        <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>GP name</th><td><p>Prefix: Dr</p><p>Given Name: John</p><p>Family Name: Lorenzo</p></td></tr><tr><th>GP practice details</th><td><p>Name: MGP Medical Centre</p><p>Address:</p><p>Address Line: 1 MGP House, Overtown</p><p>City: Leeds</p><p>Post Code: LS21 7PA</p></td></tr></tbody></table></div>
                    </text>
                    <entry>
                        <reference value="urn:uuid:12738016-98c2-49ab-b032-5558b3978993" />
                    </entry>
                </section>
                <section>
                    <title value="Medications and medical devices" />
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                            <code value="medications-and-medical-devices" />
                            <display value="Medications and medical devices" />
                        </coding>
                    </code>
                    <text>
                        <status value="extensions" />
                        <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><!-- Medication 1 --><tbody><tr><th>Medication name</th><td>Flixotide 100micrograms/dose Accuhaler (GlaxoSmithKline UK Ltd)</td></tr><tr><th>Form</th><td>Inhaler</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>2 doses to be inhaled twice daily.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width="100%"><!-- Medication 2 --><tbody><tr><th>Medication name</th><td>Salbutamol 100micrograms/dose inhaler</td></tr><tr><th>Form</th><td>Inhaler</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>Inhale 2 doses - four times daily and when required for wheezing</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width="100%"><!-- Medication 3 --><tbody><tr><th>Medication name</th><td>Epilim- oral- 200mg </td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>One tablet in the morning and two at night.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width="100%"><!-- Medication 4 --><tbody><tr><th>Medication name</th><td>Amoxicillin 500mg </td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>three times daily for 5 days</td></tr><tr><th>Status</th><td>Added</td></tr></tbody></table><table width="100%"><!-- Medication 5 --><tbody><tr><th>Medication name</th><td>Prednisolone</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>30mg once daily for 2 days. Then discontinue</td></tr><tr><th>Status</th><td>Added</td></tr></tbody></table><table width="100%"><!-- Medication 6 --><tbody><tr><th>Medication name</th><td>Microgynon </td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>follow the directions.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table></div>
                    </text>
                    <entry>
                        <reference value="urn:uuid:19c5621a-7c47-444a-9a06-82f11144640a" />
                    </entry>
                </section>
                <section>
                    <title value="Patient demographics" />
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                            <code value="patient-demographics" />
                            <display value="Patient demographics" />
                        </coding>
                    </code>
                    <text>
                        <status value="additional" />
                        <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Patient name</th><td><p>Prefix: Miss</p><p>Given Name: Trish</p><p>Family Name: Trivett</p></td></tr><tr><th>Date of birth</th><td>1 January 1989</td></tr><tr><th>Gender</th><td>Female</td></tr><tr><th>NHS number</th><td>9449307458</td></tr><tr><th>Patient address</th><td><p>Address Line: 21, Grove Street, Overtown</p><p>City: Leeds</p><p>Post Code: LS21 1PF</p></td></tr></tbody></table></div>
                    </text>
                    <entry>
                        <reference value="urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6" />
                    </entry>
                </section>
                <section>
                    <title value="Person completing record" />
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                            <code value="person-completing-record" />
                            <display value="Person completing record" />
                        </coding>
                    </code>
                    <text>
                        <status value="additional" />
                        <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Name</th><td><p>Prefix: Dr</p><p>Given Name: Paul</p><p>Family Name: Rastall</p></td></tr><tr><th>Role</th><td>Consultant</td></tr><tr><th>Professional identifier</th><td>GMC: 6122477</td></tr><tr><th>Date and time completed</th><td>27-Jan-2023 16:17</td></tr><tr><th>Contact details</th><td>Phone: 0113 6323200 (Work)</td></tr><tr><th>Organisation</th><td><p>Name: Leeds Teaching Hospitals NHS Trust,</p><p>Address Line: St James's University Hospital, Beckett Street</p><p>City: Leeds</p><p>Post Code: LS9 7TF</p></td></tr></tbody></table></div>
                    </text>
                    <entry>
                        <reference value="urn:uuid:fb5cf63f-02c7-49f2-9090-831d4846840f" />
                    </entry>
                </section>
                <section>
                    <title value="Plan and requested actions" />
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                            <code value="plan-and-requested-actions" />
                            <display value="Plan and requested actions" />
                        </coding>
                    </code>
                    <text>
                        <status value="additional" />
                        <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Actions for healthcare professionals</th><td>
                      GP please continue secondary preventative medication. 
                                 
                      <p>Status: Requested</p></td></tr></tbody></table></div>
                    </text>
                </section>
                <section>
                    <title value="Referrer details" />
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                            <code value="referrer-details" />
                            <display value="Referrer details" />
                        </coding>
                    </code>
                    <text>
                        <status value="generated" />
                        <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Referrer details</th><td><p>Name:</p><p>Prefix: Dr.</p><p>Given name: Amanda</p><p>Family name: Smith</p><p>Role: Specialist Registrar</p><p>Tel: 0113 6323222 (work)</p><p>Organisation</p><p>Name: St. James's University Hospital Accident and Emergency Department</p><p>Address Line: St James's University Hospital, Beckett Street</p><p>City: Leeds</p><p>Post Code: LS9 7TF</p></td></tr></tbody></table></div>
                    </text>
                    <entry>
                        <reference value="urn:uuid:9f81b69d-2a50-4514-abee-875e1f749fb8" />
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                    <entry>
                        <reference value="urn:uuid:94a1c11e-0950-4af5-84cf-c06a8d4d1c98" />
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            </Composition>
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            <Encounter>
                <meta>
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                </meta>
                <extension url="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AdmissionMethod">
                    <valueCodeableConcept>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-AdmissionMethodEngland" />
                            <code value="21" />
                            <display value="Accident and emergency or dental casualty department of the Health Care Provider" />
                        </coding>
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                <status value="finished" />
                <class>
                    <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode" />
                    <code value="IMP" />
                    <display value="inpatient encounter" />
                </class>
                <type>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="185212007" />
                        <display value="Seen in hospital ward" />
                    </coding>
                </type>
                <subject>
                    <reference value="urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6" />
                </subject>
                <participant>
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                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType" />
                            <code value="DIS" />
                            <display value="discharger" />
                        </coding>
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                    <individual>
                        <reference value="urn:uuid:fb5cf63f-02c7-49f2-9090-831d4846840f" />
                    </individual>
                </participant>
                <period>
                    <start value="2015-02-12T09:00:00+00:00" />
                    <end value="2015-02-16T15:00:00+00:00" />
                </period>
                <reasonCode>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="425419005" />
                        <display value="ECG: inferior ischaemia" />
                    </coding>
                </reasonCode>
                <hospitalization>
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                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-SourceOfAdmissionEngland" />
                            <code value="51" />
                            <display value="NHS other Hospital Provider - Ward for general Patients or the younger physically disabled or A and E department" />
                        </coding>
                    </admitSource>
                    <dischargeDisposition>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-DischargeDestinationEngland" />
                            <code value="19" />
                            <display value="Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes Patients with no fixed abode." />
                        </coding>
                    </dischargeDisposition>
                </hospitalization>
                <location>
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                        <reference value="urn:uuid:f79fe55e-2a96-47a4-b673-dd06d36b0977" />
                    </location>
                    <period>
                        <end value="2023-01-27T16:13:00+00:00" />
                    </period>
                </location>
            </Encounter>
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        <resource>
            <List>
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                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-List" />
                </meta>
                <status value="current" />
                <mode value="snapshot" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="1102411000000102" />
                        <display value="Active medications" />
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                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="302211009" />
                        <display value="Specialist registrar" />
                    </coding>
                </code>
            </PractitionerRole>
        </resource>
    </entry>
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        <fullUrl value="urn:uuid:12738016-98c2-49ab-b032-5558b3978993" />
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            <Organization>
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
                </meta>
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/ods-organization-code" />
                    <value value="GP123456" />
                </identifier>
                <name value="MGP Medical Centre" />
                <address>
                    <line value="1 MGP House, Overtown" />
                    <city value="Leeds" />
                    <postalCode value="LS21 7PA" />
                </address>
            </Organization>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:6ab7066c-b2bf-4543-9e86-dbf757e0dc4a" />
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            <Organization>
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
                </meta>
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/ods-organization-code" />
                    <value value="RR8" />
                </identifier>
                <name value="Leeds Teaching Hospitals NHS Trust" />
                <address>
                    <line value="St James&#39;s University Hospital, Beckett Street" />
                    <city value="Leeds" />
                    <postalCode value="LS9 7TF" />
                </address>
            </Organization>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:484a8aa6-7b70-49ae-a638-1784a4744ea3" />
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            <Organization>
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
                </meta>
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/ods-organization-code" />
                    <value value="RY6" />
                </identifier>
                <name value="Leeds Community Healthcare NHS Trust" />
            </Organization>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:94a1c11e-0950-4af5-84cf-c06a8d4d1c98" />
        <resource>
            <Organization>
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
                </meta>
                <name value="St. James&#39;s University Hospital Accident and Emergency Department" />
                <address>
                    <line value="St James&#39;s University Hospital, Beckett Street" />
                    <city value="Leeds" />
                    <postalCode value="LS9 7TF" />
                </address>
            </Organization>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:f79fe55e-2a96-47a4-b673-dd06d36b0977" />
        <resource>
            <Location>
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Location" />
                </meta>
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/local-location-identifier" />
                    <value value="RR8CRAM" />
                </identifier>
                <name value="Cramer Ward" />
                <managingOrganization>
                    <reference value="urn:uuid:6ab7066c-b2bf-4543-9e86-dbf757e0dc4a" />
                </managingOrganization>
            </Location>
        </resource>
    </entry>
</Bundle>
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