This page is part of the T17 IG (v1.0.0: draft-1 Draft) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

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: no-authorization-single-code - JSON Representation

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{
  "resourceType" : "Bundle",
  "id" : "no-authorization-single-code",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2023-10-30T12:16:52.092+00:00",
    "source" : "#OWv6TVW3y30WsF2S"
  },
  "type" : "collection",
  "entry" : [
    {
      "fullUrl" : "urn:uuid:7528e4d8-d2de-4e38-9792-eb0013e0570b",
      "resource" : {
        "resourceType" : "CoverageEligibilityResponse",
        "id" : "90f540a4-f1a8-4a8e-a031-0ed887ce980e",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"CoverageEligibilityResponse_90f540a4-f1a8-4a8e-a031-0ed887ce980e\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityResponse 90f540a4-f1a8-4a8e-a031-0ed887ce980e</b></p><a name=\"90f540a4-f1a8-4a8e-a031-0ed887ce980e\"> </a><a name=\"hc90f540a4-f1a8-4a8e-a031-0ed887ce980e\"> </a><a name=\"90f540a4-f1a8-4a8e-a031-0ed887ce980e-en-US\"> </a><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.0.0/NamingSystem-uri.html\" title=\"As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt \r\n\r\nThis oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid: \r\n\r\nNote that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.\r\n\r\nThis OID may also be used in CD.codeSystem.\">URI</a>/urn:uuid:90f540a4-f1a8-4a8e-a031-0ed887ce980e</p><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage Validation</p><p><b>patient</b>: Identifier: <code>http://fhir.leumit.co.il/identifier/magnetic-card</code>/1-123456-123456-789</p><p><b>created</b>: 2023-07-02 13:44:58+0000</p><p><b>requestor</b>: בי&quot;ח איכילוב (Identifier: Israeli Legal Entity/500106919)</p><p><b>request</b>: Identifier: <code>http://fhir.tlvmc.gov.il/identifier/preauth-req-no</code>/3772</p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: הבקשה להתחייבות לא אושרה</p><p><b>insurer</b>: לאומית (Identifier: Israeli Legal Entity/580039899)</p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: אין מספר התחייבות</p><h3>Items</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ProductOrService</b></td><td><b>Modifier</b></td><td><b>Excluded</b></td><td><b>Name</b></td><td><b>Description</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://fhir.health.gov.il/cs/medical-service-moh L9258}\">בדיקת רופא ילדים במרפאה</span></td><td><span title=\"Codes:{http://fhir.health.gov.il/cs/moh-form17-issue-code charge-not-authorized}\">ללקוח אין הרשאת חיוב</span></td><td>true</td><td>בדיקת רופא - התמחות בכליות</td><td>בדיקת רופא ילדים עם התמחות לכליות</td></tr></table></blockquote></div>"
        },
        "identifier" : [
          {
            "system" : "urn:ietf:rfc:3986",
            "value" : "urn:uuid:90f540a4-f1a8-4a8e-a031-0ed887ce980e"
          }
        ],
        "status" : "active",
        "purpose" : [
          "validation"
        ],
        "patient" : {
          "identifier" : {
            "system" : "http://fhir.leumit.co.il/identifier/magnetic-card",
            "value" : "1-123456-123456-789"
          }
        },
        "created" : "2023-07-02T13:44:58.429Z",
        "requestor" : {
          "type" : "Organization",
          "identifier" : {
            "system" : "http://fhir.health.gov.il/identifier/legal-entity",
            "value" : "500106919"
          },
          "display" : "בי\"ח איכילוב"
        },
        "request" : {
          "identifier" : {
            "system" : "http://fhir.tlvmc.gov.il/identifier/preauth-req-no",
            "value" : "3772"
          }
        },
        "outcome" : "complete",
        "disposition" : "הבקשה להתחייבות לא אושרה",
        "insurer" : {
          "identifier" : {
            "system" : "http://fhir.health.gov.il/identifier/legal-entity",
            "value" : "580039899"
          },
          "display" : "לאומית"
        },
        "insurance" : [
          {
            "coverage" : {
              "display" : "אין מספר התחייבות"
            },
            "item" : [
              {
                "productOrService" : {
                  "coding" : [
                    {
                      "system" : "http://fhir.health.gov.il/cs/medical-service-moh",
                      "code" : "L9258",
                      "display" : "בדיקת רופא ילדים במרפאה"
                    }
                  ]
                },
                "modifier" : [
                  {
                    "coding" : [
                      {
                        "system" : "http://fhir.health.gov.il/cs/moh-form17-issue-code",
                        "code" : "charge-not-authorized",
                        "display" : "ללקוח אין הרשאת חיוב"
                      }
                    ]
                  }
                ],
                "excluded" : true,
                "name" : "בדיקת רופא - התמחות בכליות",
                "description" : "בדיקת רופא ילדים עם התמחות לכליות"
              }
            ]
          }
        ]
      }
    }
  ]
}