Belgian MyCareNet Profiles
2.0.0 - STU Belgium flag

This page is part of the HL7 Belgium FHIR Implementation Guide - MyCareNet profiles (v2.0.0: Trial Use) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: ex06 - JSON Representation

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{
  "resourceType" : "Bundle",
  "id" : "ex06",
  "meta" : {
    "profile" : [
      "https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementdemandreply"
    ]
  },
  "type" : "message",
  "timestamp" : "2015-07-14T11:15:37+02:00",
  "entry" : [
    {
      "fullUrl" : "urn:uuid:ce2e2084-3f5c-4f52-8551-8088bb6d3491",
      "resource" : {
        "resourceType" : "MessageHeader",
        "id" : "667b18ce-3d37-4581-9baa-6fada338038c",
        "meta" : {
          "profile" : [
            "https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-messageheader"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: MessageHeader</b><a name=\"667b18ce-3d37-4581-9baa-6fada338038c\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource MessageHeader &quot;667b18ce-3d37-4581-9baa-6fada338038c&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-be-messageheader.html\">MyCareNet MessageHeader BE profile</a></p></div><p><b>event</b>: claimresponse-decide (Details: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events code claimresponse-decide = 'claimresponse-decide', stated as 'null')</p><h3>Destinations</h3><table class=\"grid\"><tr><td>-</td><td><b>Endpoint</b></td><td><b>Receiver</b></td></tr><tr><td>*</td><td><code>urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3</code></td><td><a href=\"#PractitionerRole_PractitionerRole1\">See above (PractitionerRole/PractitionerRole1)</a></td></tr></table><p><b>sender</b>: <a href=\"#Organization_OrganizationIO1\">See above (Organization/OrganizationIO1)</a></p><h3>Sources</h3><table class=\"grid\"><tr><td>-</td><td><b>Endpoint</b></td></tr><tr><td>*</td><td><code>urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358</code></td></tr></table><h3>Responses</h3><table class=\"grid\"><tr><td>-</td><td><b>Identifier</b></td><td><b>Code</b></td></tr><tr><td>*</td><td>267b18ce-3d37-4581-9baa-6fada338038b</td><td>ok</td></tr></table><p><b>focus</b>: <a href=\"#ClaimResponse_ClaimResponse1\">See above (ClaimResponse/ClaimResponse1)</a></p></div>"
        },
        "eventCoding" : {
          "system" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events",
          "code" : "claimresponse-decide"
        },
        "destination" : [
          {
            "endpoint" : "urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3",
            "receiver" : {
              "reference" : "PractitionerRole/PractitionerRole1"
            }
          }
        ],
        "sender" : {
          "reference" : "Organization/OrganizationIO1"
        },
        "source" : {
          "endpoint" : "urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358"
        },
        "response" : {
          "identifier" : "267b18ce-3d37-4581-9baa-6fada338038b",
          "code" : "ok"
        },
        "focus" : [
          {
            "reference" : "ClaimResponse/ClaimResponse1"
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3",
      "resource" : {
        "resourceType" : "PractitionerRole",
        "id" : "PractitionerRole1",
        "meta" : {
          "profile" : [
            "https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: PractitionerRole</b><a name=\"PractitionerRole1\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource PractitionerRole &quot;PractitionerRole1&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-practitionerrole.html\">Practitioner role core BE profile</a></p></div><p><b>practitioner</b>: <a href=\"#Practitioner_Practitioner1\">See above (Practitioner/Practitioner1)</a></p><p><b>code</b>: physiotherapist <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/CodeSystem-cd-hcparty.html\">HCParty</a>#persphysiotherapist)</span></p></div>"
        },
        "practitioner" : {
          "reference" : "Practitioner/Practitioner1"
        },
        "code" : [
          {
            "coding" : [
              {
                "system" : "https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty",
                "code" : "persphysiotherapist"
              }
            ]
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931",
      "resource" : {
        "resourceType" : "Practitioner",
        "id" : "Practitioner1",
        "meta" : {
          "profile" : [
            "https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Practitioner</b><a name=\"Practitioner1\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Practitioner &quot;Practitioner1&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-practitioner.html\">Practitioner core BE profile</a></p></div><p><b>identifier</b>: id:\u00a054263481527</p><p><b>name</b>: John Smith </p></div>"
        },
        "identifier" : [
          {
            "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi",
            "value" : "54263481527"
          }
        ],
        "name" : [
          {
            "family" : "Smith",
            "given" : [
              "John"
            ]
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "OrganizationIO1",
        "meta" : {
          "profile" : [
            "https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"OrganizationIO1\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Organization &quot;OrganizationIO1&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-organization.html\">Organisation core BE profile</a></p></div><p><b>identifier</b>: id:\u00a0300</p><p><b>name</b>: Union Nationale des Mutualités Socialistes - Nationaal Verbond van de Socialistische Mutualiteiten</p></div>"
        },
        "identifier" : [
          {
            "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancenumber",
            "value" : "300"
          }
        ],
        "name" : "Union Nationale des Mutualités Socialistes - Nationaal Verbond van de Socialistische Mutualiteiten"
      }
    },
    {
      "fullUrl" : "urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686",
      "resource" : {
        "resourceType" : "Patient",
        "id" : "Patient1",
        "meta" : {
          "profile" : [
            "https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Patient</b><a name=\"Patient1\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Patient &quot;Patient1&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-patient.html\">Patient core BE profile</a></p></div><p><b>identifier</b>: id:\u00a0n° inscription mutualiste</p><p><b>name</b>: Jean Dupont </p><p><b>gender</b>: male</p></div>"
        },
        "identifier" : [
          {
            "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancymembership",
            "value" : "n° inscription mutualiste",
            "assigner" : {
              "identifier" : {
                "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancenumber",
                "value" : "n° mutualité"
              }
            }
          }
        ],
        "name" : [
          {
            "family" : "Dupont",
            "given" : [
              "Jean"
            ]
          }
        ],
        "gender" : "male"
      }
    },
    {
      "fullUrl" : "urn:uuid:0a0d60df-0340-45a6-a493-a5d67f74d693",
      "resource" : {
        "resourceType" : "ClaimResponse",
        "id" : "ClaimResponse1",
        "meta" : {
          "profile" : [
            "https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</b><a name=\"ClaimResponse1\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource ClaimResponse &quot;ClaimResponse1&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-be-eagreementclaimresponse.html\">MyCareNet eAgreement Claim Response BE profile</a></p></div><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#professional)</span></p><p><b>subType</b>: physiotherapy-fb <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-agreement-types.html\">CodeSystem agreement types</a>#physiotherapy-fb)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"#Patient_Patient1\">See above (Patient/Patient1)</a></p><p><b>created</b>: 2015-07-14 11:15:30+0200</p><p><b>insurer</b>: <a href=\"#Organization_OrganizationIO1\">See above (Organization/OrganizationIO1)</a></p><p><b>requestor</b>: <a href=\"#PractitionerRole_PractitionerRole1\">See above (PractitionerRole/PractitionerRole1)</a></p><p><b>outcome</b>: complete</p><p><b>preAuthRef</b>: identifiant business de la décision (accord/refus/en traitement)</p><blockquote><p><b>addItem</b></p><p><b>itemSequence</b>: 1</p><p><b>productOrService</b>: fb-51 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-nihdi-physiotherapy-pathologysituationcode.html\">CodeSystem NIHDIPhysiotherapyPathology</a>#fb-51)</span></p><h3>Adjudications</h3><table class=\"grid\"><tr><td>-</td><td><b>Category</b></td><td><b>Reason</b></td></tr><tr><td>*</td><td>refusal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-decision-values.html\">CodeSystem decision values</a>#refusal)</span></td><td>ajout de commentaires sur le refus <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-refusal-values.html\">CodeSystem refusal values</a>#REF_AGREE_ALL_001)</span></td></tr></table></blockquote></div>"
        },
        "status" : "active",
        "type" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
              "code" : "professional"
            }
          ]
        },
        "subType" : {
          "coding" : [
            {
              "system" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types",
              "code" : "physiotherapy-fb"
            }
          ]
        },
        "use" : "preauthorization",
        "patient" : {
          "reference" : "Patient/Patient1"
        },
        "created" : "2015-07-14T11:15:30+02:00",
        "insurer" : {
          "reference" : "Organization/OrganizationIO1"
        },
        "requestor" : {
          "reference" : "PractitionerRole/PractitionerRole1"
        },
        "outcome" : "complete",
        "preAuthRef" : "identifiant business de la décision (accord/refus/en traitement)",
        "addItem" : [
          {
            "itemSequence" : [
              1
            ],
            "productOrService" : {
              "coding" : [
                {
                  "system" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/nihdi-physiotherapy-pathologysituationcode",
                  "code" : "fb-51"
                }
              ]
            },
            "adjudication" : [
              {
                "category" : {
                  "coding" : [
                    {
                      "system" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values",
                      "code" : "refusal"
                    }
                  ]
                },
                "reason" : {
                  "coding" : [
                    {
                      "system" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/refusal-values",
                      "code" : "REF_AGREE_ALL_001"
                    }
                  ],
                  "text" : "ajout de commentaires sur le refus"
                }
              }
            ]
          }
        ]
      }
    }
  ]
}