Message: Authorization Institutional Request #1 - Healthcare Financial Services IG Edition 1 v0.3.0

Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Example Bundle: Message: Authorization Institutional Request #1

Generated Narrative: Bundle a84aabfa-1163-407d-aa38-f8119a0b7383

Profile: Nphies Bundle

Bundle a84aabfa-1163-407d-aa38-f8119a0b7383 of type message

Entry 1 - fullUrl = urn:uuid:a7e4caf2-0441-40e5-97d2-5ae180273069

Resource MessageHeader:

Generated Narrative: MessageHeader a7e4caf2-0441-40e5-97d2-5ae180273069

Profile: Nphies MessageHeader
event: KSA Message Events priorauth-request: Prior Authorization Request
Destinations
- Receiver
* Identifier: http://nphies.sa/license/payer-license/INS-FHIR
sender: Identifier: http://nphies.sa/license/provider-license/PR-FHIR
source
focus: Bundle: type = message; timestamp = 2021-08-30 09:20:15+0300

Entry 2 - fullUrl = http://saudigeneralhospital.com.sa/Claim/483069

Resource Claim:

Generated Narrative: Claim 483069

Profile: Nphies Authorization Institutional
Encounter: Encounter: identifier = http://saudigeneralhospital.com.sa/identifiers/encounter#AB0001; status = planned; class = short stay (ActCode#SS); serviceType = Sub-Acute Care; period = 2023-12-04 10:25:00+0300 --> 2023-12-04 12:30:00+0300
Eligibility Offline Reference: EligResp-31212432
Eligibility Offline Date: 2023-12-04
identifier: http://saudigeneralhospital.com.sa/identifiers/authorization/req_1124856069
status: Active
type: Institutional
subType: InPatient
use: Preauthorization
patient: Muhammad Khaled Abbas(official) Male, DoB: 2010-08-21 ( Permanent Resident Card Number: 2000000002)
created: 2023-12-04 06:38:00+0300
insurer: Organization Saudi National Insurance
provider: Organization Saudi General Hospital
priority: Normal
Payees
- Type
* Provider
CareTeams
- Sequence Provider Role
* 1 Practitioner Dr. Ameera Hassan(official) Primary provider
supportingInfo
sequence: 1
category: Systolic
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 120 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')
supportingInfo
sequence: 2
category: Diastolic
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 80 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')
supportingInfo
sequence: 3
category: Height
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 160 cm (Details: UCUM codecm = 'cm')
supportingInfo
sequence: 4
category: Weight
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 129 kg (Details: UCUM codekg = 'kg')
supportingInfo
sequence: 5
category: Pulse
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 100 /min (Details: UCUM code/min = '/min')
supportingInfo
sequence: 6
category: Temperature
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 37 Cel (Details: UCUM codeCel = 'Cel')
supportingInfo
sequence: 7
category: chief complaint
code: Acute appendicitis with generalized peritonitis
supportingInfo
sequence: 8
category: Oxygen Saturation
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 100 % (Details: UCUM code% = '%')
supportingInfo
sequence: 9
category: Respiratory Rate
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 70 /min (Details: UCUM code/min = '/min')
supportingInfo
sequence: 10
category: Admission Weight
value: 129 kg (Details: UCUM codekg = 'kg')
supportingInfo
sequence: 11
category: Estimated Length Of Stay
value: 1 d (Details: UCUM coded = 'd')
supportingInfo
sequence: 12
category: patient history
value: No systemic disease
supportingInfo
sequence: 13
category: Investigation Result
code: Investigation(s) not performed
supportingInfo
sequence: 14
category: Treatment Plan
value: Appendectomy
supportingInfo
sequence: 15
category: Physical Examination
value: Stable
supportingInfo
sequence: 16
category: history Of Present Illness
value: No history
Diagnoses
- Sequence Diagnosis[x] Type OnAdmission
* 1 Acute appendicitis with generalized peritonitis Principal Diagnosis No
Insurances
- Sequence Focal Coverage
* 1 true Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000002; status = active; type = extended healthcare; relationship = Child; network = Golden C
item
Package Code: false
Patient Share: SAR0.00 (SAR)
Payer Share: SAR400.00 (SAR)
Maternity: false
Tax: SAR100.00 (SAR)
sequence: 1
careTeamSequence: 1
diagnosisSequence: 1
informationSequence: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16
productOrService: Appendicectomy
serviced: 2023-12-04
quantity: 1
UnitPrices
- Value Currency
* 300 SAR
Nets
- Value Currency
* 400 SAR
Totals
- Value Currency
* 400 SAR

Entry 3 - fullUrl = http://saudigeneralhospital.com.sa/Coverage/1334

Resource Coverage:

Generated Narrative: Coverage 1334

Profile: Nphies Coverage
identifier: http://sni.com.sa/identifiers/memberid/0000000002
status: Active
type: extended healthcare
policyHolder: Organization Policy Holder Organization
subscriber: Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)
beneficiary: Muhammad Khaled Abbas(official) Male, DoB: 2010-08-21 ( Permanent Resident Card Number: 2000000002)
relationship: Child
Classes
- Type Value Name
* Plan CB135 Insurance Plan A
network: Golden C

Entry 4 - fullUrl = http://saudigeneralhospital.com.sa/Organization/13

Resource Organization:

Generated Narrative: Organization 13

Profile: Nphies Policy Holder Organization
identifier: http://nphies.sa/identifiers/organization/5009
active: true
name: Policy Holder Organization

Entry 5 - fullUrl = http://saudigeneralhospital.com.sa/Organization/b1b3432921324f97af3be9fd0b1a14ae

Resource Organization:

Generated Narrative: Organization b1b3432921324f97af3be9fd0b1a14ae

Profile: Nphies Provider Organization
Provider Type: Hospital
identifier: http://nphies.sa/license/provider-license/PR-FHIR
active: true
type: Healthcare Provider
name: Saudi General Hospital
Contacts
- Address
* Salamah Street, Building 25, Suite 2, Riyadh Saudi Arabia(work)

Entry 6 - fullUrl = http://saudigeneralhospital.com.sa/Patient/173826788

Resource Patient:

Generated Narrative: Patient 173826788

Profile: Nphies Patient
Muhammad Khaled Abbas(official) Male, DoB: 2010-08-21 ( Permanent Resident Card Number: 2000000002)
Active: true Marital Status: unmarried
Contact Detail +966517382691
Patient Occupation Student

Entry 7 - fullUrl = http://saudigeneralhospital.com.sa/Patient/123454186

Resource Patient:

Generated Narrative: Patient 123454186

Profile: Nphies Patient
Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)
Active: true Deceased: false
Marital Status: Married
Contact Detail
+966512345691
Salamah Street, Building 25, Suite 2, Saudi Arabia(home)
Patient Occupation Business

Entry 8 - fullUrl = http://saudigeneralhospital.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db

Resource Organization:

Generated Narrative: Organization bff3aa1fbd3648619ac082357bf135db

Profile: Nphies Insurer Organization
identifier: National Insurance Organization Identifier/INS-FHIR (use: official, )
active: true
type: Insurance Company
name: Saudi National Insurance
Contacts
- Address
* Olaya Street, Building 70, Riyadh Saudi Arabia(work)

Entry 9 - fullUrl = http://saudigeneralhospital.com.sa/Practitioner/1

Resource Practitioner:

Generated Narrative: Practitioner 1

Profile: Nphies Practitioner
identifier: Provider number/N-P-00001
active: true
name: Dr. Ameera Hassan(Official)

Entry 10 - fullUrl = http://saudigeneralhospital.com.sa/Encounter/10124

Resource Encounter:

Generated Narrative: Encounter 10124

Profile: Nphies Encounter SS (Auth)
identifier: http://saudigeneralhospital.com.sa/identifiers/encounter/AB0001
status: Planned
class: short stay
serviceType: No display for Encounter.serviceType (concept: Sub-Acute Care)
subject: Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)
serviceProvider: Organization Saudi General Hospital