SRxDataRequest Example

Download Raw SRxDataRequest json example


{
    "resourceType": "Bundle",
    "id": "example-SRxDataRequest-Bundle",
    "language": "en-US",
    "type": "message",
    "timestamp": "2022-02-03T08:01:48.794+00:00",
    "entry":  [
        {
            "resource": {
                "resourceType": "MessageHeader",
                "id": "620b9e7f5fd54adda8d161becce5a536",
                "eventCoding": {
                    "system": "http://fhirdocs.surescripts.net/message-events",
                    "code": "specialty-data-request"
                },
                "destination":  [
                    {
                        "name": "Acme Message Gateway",
                        "target": {
                            "reference": "Device/example"
                        },
                        "endpoint": "llp:10.11.12.14:5432"
                    }
                ],
                "sender": {
                    "reference": "urn:uuid:a716f94a-2e39-447d-bd00-4bed52f37184"
                },
                "source": {
                    "name": "Surescripts, LLC (Staging)",
                    "software": "Workbench Specialty Testing Tools",
                    "endpoint": "B3C4BFEE81A64EA3ADC0FF33D386EED1"
                },
                "focus":  [
                    {
                        "reference": "urn:uuid:4f2743cb-b5b5-43a5-9f92-93d13e331633"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:4f2743cb-b5b5-43a5-9f92-93d13e331633",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "4f2743cb-b5b5-43a5-9f92-93d13e331633",
                "identifier":  [
                    {
                        "type": {
                            "coding":  [
                                {
                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                                    "code": "PLAC",
                                    "display": "Placer Identifier"
                                }
                            ],
                            "text": "Prescriber Order Number"
                        },
                        "value": "PON7777777",
                        "assigner": {
                            "display": "MyEHR-777"
                        }
                    },
                    {
                        "system": "urn://myehr.com/namespace/hl7/1",
                        "value": "9941339108"
                    },
                    {
                        "system": "urn://myehr.com/namespace/hl7/20",
                        "value": "abc"
                    }
                ],
                "status": "active",
                "intent": "filler-order",
                "medicationCodeableConcept": {
                    "coding":  [
                        {
                            "system": "http://hl7.org/fhir/sid/ndc",
                            "code": "68788729801"
                        },
                        {
                            "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
                            "code": "1741049"
                        }
                    ],
                    "text": "CHIDEBETINOL 3 MCG"
                },
                "subject": {
                    "reference": "urn:uuid:7dfed5cc-99b5-48be-829b-3ea749fa963a",
                    "type": "Patient"
                },
                "authoredOn": "2023-05-09T20:59:49.5019483Z",
                "requester": {
                    "reference": "urn:uuid:a716f94a-2e39-447d-bd00-4bed52f37184",
                    "type": "Practitioner"
                },
                "performer": {
                    "reference": "urn:uuid:0b4ddfe8-c96f-45e7-b0de-e66dc375d5b8",
                    "type": "Organization"
                },
                "reasonCode":  [
                    {
                        "coding":  [
                            {
                                "system": "http://hl7.org/fhir/sid/icd-10",
                                "code": "D10.2"
                            }
                        ],
                        "text": "Mysotaesis poisoning"
                    }
                ],
                "reasonReference":  [
                    {
                        "reference": "urn:uuid:9e95ceeb-a029-4956-8b13-6c346e63fe10",
                        "type": "Condition"
                    }
                ],
                "groupIdentifier": {
                    "value": "1664224781150",
                    "assigner": {
                        "display": "MyEHR-123"
                    }
                },
                "dosageInstruction":  [
                    {
                        "text": "1 PO QD"
                    }
                ],
                "dispenseRequest": {
                    "quantity": {
                        "value": 30,
                        "unit": "tablets",
                        "system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
                        "code": "tablets"
                    },
                    "expectedSupplyDuration": {
                        "value": 30,
                        "unit": "days",
                        "system": "http://unitsofmeasure.org",
                        "code": "d"
                    }
                }
            }
        },
        {
            "fullUrl": "urn:uuid:7dfed5cc-99b5-48be-829b-3ea749fa963a",
            "resource": {
                "resourceType": "Patient",
                "id": "7dfed5cc-99b5-48be-829b-3ea749fa963a",
                "identifier":  [
                    {
                        "use": "official",
                        "type": {
                            "coding":  [
                                {
                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                                    "code": "MR",
                                    "display": "Medical Record Number"
                                }
                            ],
                            "text": "Medical Record Number"
                        },
                        "system": "urn://myehr.com/namespace/hl7/3",
                        "value": "7dfed5cc-99b5-48be-829b-3ea749fa963a"
                    },
                    {
                        "system": "urn://myehr.com/namespace/hl7/3",
                        "value": "999-99-9999"
                    }
                ],
                "active": true,
                "name":  [
                    {
                        "use": "official",
                        "text": "Jane Doe",
                        "family": "Doe",
                        "given":  [
                            "Jane"
                        ]
                    }
                ],
                "telecom":  [
                    {
                        "system": "email",
                        "value": "d.h@bom.com",
                        "rank": 1
                    },
                    {
                        "extension":  [
                            {
                                "url": "http://hl7.org/fhir/StructureDefinition/contactpoint-extension",
                                "valueString": "123"
                            }
                        ],
                        "system": "phone",
                        "value": "9715551111",
                        "rank": 1
                    },
                    {
                        "system": "fax",
                        "value": "8005551312",
                        "rank": 1
                    },
                    {
                        "system": "phone",
                        "value": "4155552222",
                        "use": "home"
                    },
                    {
                        "extension":  [
                            {
                                "url": "http://hl7.org/fhir/StructureDefinition/contactpoint-extension",
                                "valueString": "124"
                            }
                        ],
                        "system": "phone",
                        "value": "8775553333",
                        "use": "work"
                    },
                    {
                        "system": "phone",
                        "value": "8665554444",
                        "use": "mobile"
                    }
                ],
                "gender": "female",
                "birthDate": "2000-02-20",
                "deceasedBoolean": false,
                "address":  [
                    {
                        "type": "postal",
                        "line":  [
                            "1877 189th"
                        ],
                        "city": "Beaverton",
                        "state": "OR",
                        "postalCode": "97006",
                        "country": "US"
                    }
                ],
                "contact":  [
                    {
                        "relationship":  [
                            {
                                "coding":  [
                                    {
                                        "system": "http://terminology.hl7.org/CodeSystem/v2-0131",
                                        "code": "N"
                                    }
                                ]
                            }
                        ],
                        "name": {
                            "family": "du Marche",
                            "_family": {
                                "extension":  [
                                    {
                                        "url": "http://hl7.org/fhir/StructureDefinition/humanname-own-prefix",
                                        "valueString": "VV"
                                    }
                                ]
                            },
                            "given":  [
                                "Benedicte"
                            ]
                        },
                        "telecom":  [
                            {
                                "system": "phone",
                                "value": "+33 (237) 998327"
                            }
                        ],
                        "address": {
                            "use": "home",
                            "type": "both",
                            "line":  [
                                "534 Erewhon St"
                            ],
                            "city": "PleasantVille",
                            "district": "Rainbow",
                            "state": "Vic",
                            "postalCode": "3999",
                            "period": {
                                "start": "1974-12-25"
                            }
                        },
                        "gender": "female",
                        "period": {
                            "start": "2012"
                        }
                    }
                ],
                "communication":  [
                    {
                        "language": {
                            "coding":  [
                                {
                                    "system": "urn:ietf:bcp:47",
                                    "code": "en",
                                    "display": "English"
                                }
                            ]
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:0b4ddfe8-c96f-45e7-b0de-e66dc375d5b8",
            "resource": {
                "resourceType": "Organization",
                "id": "0b4ddfe8-c96f-45e7-b0de-e66dc375d5b8",
                "identifier":  [
                    {
                        "use": "official",
                        "type": {
                            "coding":  [
                                {
                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                                    "code": "PRN",
                                    "display": "Provider Number"
                                }
                            ],
                            "text": "Provider Number"
                        },
                        "system": "http://ncpdp.org/provider-id",
                        "value": "9876546",
                        "assigner": {
                            "identifier": {
                                "system": "urn:ietf:rfc:3986",
                                "value": "urn:oid:2.16.840.1.113883.3.79"
                            }
                        }
                    },
                    {
                        "use": "official",
                        "type": {
                            "coding":  [
                                {
                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                                    "code": "PRN",
                                    "display": "Provider Number"
                                }
                            ],
                            "text": "Provider Number"
                        },
                        "system": "http://hl7.org/fhir/sid/us-npi",
                        "value": "1093759540"
                    }
                ],
                "active": true,
                "type":  [
                    {
                        "coding":  [
                            {
                                "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                                "code": "prov",
                                "display": "Healthcare Provider"
                            }
                        ],
                        "text": "Pharmacy"
                    }
                ],
                "name": "T12.Dev.RLE.Electronic",
                "telecom":  [
                    {
                        "system": "email",
                        "value": "manager@smart.com",
                        "rank": 1
                    },
                    {
                        "extension":  [
                            {
                                "url": "http://hl7.org/fhir/StructureDefinition/contactpoint-extension",
                                "valueString": "123"
                            }
                        ],
                        "system": "phone",
                        "value": "8005432121",
                        "rank": 1
                    },
                    {
                        "system": "fax",
                        "value": "5034567890",
                        "rank": 1
                    }
                ],
                "address":  [
                    {
                        "type": "postal",
                        "line":  [
                            "123 Fake St"
                        ],
                        "city": "Timber",
                        "state": "OR",
                        "postalCode": "97008",
                        "country": "US"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:a716f94a-2e39-447d-bd00-4bed52f37184",
            "resource": {
                "resourceType": "Practitioner",
                "id": "a716f94a-2e39-447d-bd00-4bed52f37184",
                "identifier":  [
                    {
                        "use": "secondary",
                        "type": {
                            "coding":  [
                                {
                                    "system": "Surescripts",
                                    "code": "SPI"
                                }
                            ]
                        },
                        "system": "http://fhirdocs.surescripts.net/spi",
                        "value": "4725438108001"
                    },
                    {
                        "use": "official",
                        "type": {
                            "coding":  [
                                {
                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                                    "code": "PRN",
                                    "display": "Provider Number"
                                }
                            ],
                            "text": "Provider Number"
                        },
                        "system": "http://hl7.org/fhir/sid/us-npi",
                        "value": "1257237549"
                    },
                    {
                        "use": "official",
                        "type": {
                            "coding":  [
                                {
                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                                    "code": "PRN",
                                    "display": "Provider Number"
                                }
                            ],
                            "text": "Provider Number"
                        },
                        "system": "http://hl7.org/fhir/sid/us-medicare",
                        "value": "G12345"
                    },
                    {
                        "use": "official",
                        "type": {
                            "coding":  [
                                {
                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                                    "code": "PRN",
                                    "display": "Provider Number"
                                }
                            ],
                            "text": "Provider Number"
                        },
                        "system": "urn:oid:2.16.840.1.113883.4.290",
                        "value": "123456789"
                    },
                    {
                        "use": "official",
                        "type": {
                            "coding":  [
                                {
                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                                    "code": "PRN",
                                    "display": "Provider Number"
                                }
                            ],
                            "text": "Provider Number"
                        },
                        "system": "urn:oid:2.16.840.1.113883.4.814",
                        "value": "CS2121212"
                    }
                ],
                "active": true,
                "name":  [
                    {
                        "use": "official",
                        "text": "Dr. Rufus B.",
                        "family": "Provider",
                        "given":  [
                            "Specialty"
                        ],
                        "prefix":  [
                            "Dr."
                        ],
                        "suffix":  [
                            "Jr."
                        ]
                    }
                ],
                "telecom":  [
                    {
                        "system": "email",
                        "value": "barleyr@procto.com",
                        "rank": 1
                    },
                    {
                        "extension":  [
                            {
                                "url": "http://hl7.org/fhir/StructureDefinition/contactpoint-extension",
                                "valueString": "44"
                            }
                        ],
                        "system": "phone",
                        "value": "5595551212",
                        "rank": 1
                    },
                    {
                        "system": "fax",
                        "value": "4565551212",
                        "rank": 1
                    }
                ],
                "address":  [
                    {
                        "type": "postal",
                        "line":  [
                            "66 Tat Ave"
                        ],
                        "city": "Timber",
                        "state": "OR",
                        "postalCode": "97008",
                        "country": "US"
                    }
                ]
            }
        }
    ]
}