{
  "resourceType": "Bundle",
  "type": "transaction",
  "entry": [ {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250",
    "resource": {
      "resourceType": "Patient",
      "id": "a00b5c95-fed5-f472-749b-6b3140ead250",
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated by <a href=\"https://github.com/synthetichealth/synthea\">Synthea</a>.Version identifier: 7e08387\n .   Person seed: -6914331003601947534  Population seed: 1784730135182</div>"
      },
      "extension": [ {
        "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
        "extension": [ {
          "url": "ombCategory",
          "valueCoding": {
            "system": "urn:oid:2.16.840.1.113883.6.238",
            "code": "2106-3",
            "display": "White"
          }
        }, {
          "url": "text",
          "valueString": "White"
        } ]
      }, {
        "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
        "extension": [ {
          "url": "ombCategory",
          "valueCoding": {
            "system": "urn:oid:2.16.840.1.113883.6.238",
            "code": "2186-5",
            "display": "Not Hispanic or Latino"
          }
        }, {
          "url": "text",
          "valueString": "Not Hispanic or Latino"
        } ]
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
        "valueString": "April374 Cronin387"
      }, {
        "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
        "valueCode": "M"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/birthPlace",
        "valueAddress": {
          "city": "Amherst",
          "state": "Massachusetts",
          "country": "US"
        }
      }, {
        "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
        "valueDecimal": 0.04940927322498879
      }, {
        "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
        "valueDecimal": 18.95059072677501
      } ],
      "identifier": [ {
        "system": "https://github.com/synthetichealth/synthea",
        "value": "a00b5c95-fed5-f472-749b-6b3140ead250"
      }, {
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/v2/0203",
            "code": "MR",
            "display": "Medical Record Number"
          } ],
          "text": "Medical Record Number"
        },
        "system": "http://hospital.smarthealthit.org",
        "value": "a00b5c95-fed5-f472-749b-6b3140ead250"
      }, {
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/identifier-type",
            "code": "SB",
            "display": "Social Security Number"
          } ],
          "text": "Social Security Number"
        },
        "system": "http://hl7.org/fhir/sid/us-ssn",
        "value": "999-80-8056"
      }, {
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/v2/0203",
            "code": "DL",
            "display": "Driver's license number"
          } ],
          "text": "Driver's license number"
        },
        "system": "urn:oid:2.16.840.1.113883.4.3.25",
        "value": "S99979529"
      }, {
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/v2/0203",
            "code": "PPN",
            "display": "Passport Number"
          } ],
          "text": "Passport Number"
        },
        "system": "http://hl7.org/fhir/sid/passport-USA",
        "value": "X31826082X"
      } ],
      "name": [ {
        "use": "official",
        "family": "Borer986",
        "given": [ "Toby274", "Gabriel934" ],
        "prefix": [ "Mr." ]
      } ],
      "telecom": [ {
        "system": "phone",
        "value": "555-965-6497",
        "use": "home"
      } ],
      "gender": "male",
      "birthDate": "2006-04-22",
      "address": [ {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/geolocation",
          "extension": [ {
            "url": "latitude",
            "valueDecimal": 42.656727662879035
          }, {
            "url": "longitude",
            "valueDecimal": -71.06356982114485
          } ]
        } ],
        "line": [ "590 Mayert Quay Unit 26" ],
        "city": "North Andover",
        "state": "Massachusetts",
        "postalCode": "00000",
        "country": "US"
      } ],
      "maritalStatus": {
        "coding": [ {
          "system": "http://hl7.org/fhir/v3/MaritalStatus",
          "code": "S",
          "display": "Never Married"
        } ],
        "text": "Never Married"
      },
      "multipleBirthBoolean": false,
      "communication": [ {
        "language": {
          "coding": [ {
            "system": "urn:ietf:bcp:47",
            "code": "en-US",
            "display": "English (United States)"
          } ],
          "text": "English (United States)"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Patient"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-64d3-8d936947a5e5",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-64d3-8d936947a5e5",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "410620009",
          "display": "Well child visit (procedure)"
        } ],
        "text": "Well child visit (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999943696",
          "display": "Dr. Claribel706 Wuckert783"
        }
      } ],
      "period": {
        "start": "2015-04-25T03:16:29+00:00",
        "end": "2015-04-25T03:31:29+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3de6-aba553f2dab2",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-3de6-aba553f2dab2",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "314529007",
          "display": "Medication review due (situation)"
        } ],
        "text": "Medication review due (situation)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-64d3-8d936947a5e5"
      },
      "onsetDateTime": "2015-04-25T03:16:29+00:00",
      "abatementDateTime": "2017-05-06T03:16:29+00:00",
      "assertedDate": "2015-04-25T03:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-dd45-7e24fe82185d",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-dd45-7e24fe82185d",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2015-04-25T03:16:29+00:00",
        "end": "2015-04-25T03:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-3de6-aba553f2dab2"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-64d3-8d936947a5e5"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      } ],
      "total": {
        "value": 136.80,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:a977c5a6-2014-ef26-0fb3-1da34942ab16",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "a977c5a6-2014-ef26-0fb3-1da34942ab16",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-dd45-7e24fe82185d"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2015-04-25T03:31:29+00:00",
        "end": "2016-04-25T03:31:29+00:00"
      },
      "provider": {
        "identifier": {
          "value": "2e3b72c0-7af9-3c34-a705-d894aacce6ac"
        }
      },
      "organization": {
        "identifier": {
          "value": "6f90eaad-abe3-3ce0-b9a6-2031c5674f0d"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999943696"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-3de6-aba553f2dab2"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.360000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 109.44000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      } ],
      "totalCost": {
        "value": 568.20,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 109.44000000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-8916-f79292bdb9ee",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "410620009",
          "display": "Well child visit (procedure)"
        } ],
        "text": "Well child visit (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999943696",
          "display": "Dr. Claribel706 Wuckert783"
        }
      } ],
      "period": {
        "start": "2017-05-06T03:16:29+00:00",
        "end": "2017-05-06T03:31:29+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a7a7-1ef957191a24",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-a7a7-1ef957191a24",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "Body Height"
        } ],
        "text": "Body Height"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 147.90,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3550-44e6b9a5a70e",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-3550-44e6b9a5a70e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72514-3",
          "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
        } ],
        "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 3,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a59a-fd0c376707ef",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-a59a-fd0c376707ef",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "29463-7",
          "display": "Body Weight"
        } ],
        "text": "Body Weight"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 39.200,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7c38-4538b0ca2af8",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-7c38-4538b0ca2af8",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "Body mass index (BMI) [Ratio]"
        } ],
        "text": "Body mass index (BMI) [Ratio]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 17.950,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-1bec-040f0f0dddc6",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-1bec-040f0f0dddc6",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "59576-9",
          "display": "Body mass index (BMI) [Percentile] Per age and sex"
        } ],
        "text": "Body mass index (BMI) [Percentile] Per age and sex"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 62.478,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b059-1489fd9e0fbf",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-b059-1489fd9e0fbf",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "85354-9",
          "display": "Blood pressure panel with all children optional"
        } ],
        "text": "Blood pressure panel with all children optional"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 82,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic Blood Pressure"
          } ],
          "text": "Systolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 125,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4670-b2a1690f9063",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-4670-b2a1690f9063",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "Heart rate"
        } ],
        "text": "Heart rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 98,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7cb4-d94a0cb976df",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-7cb4-d94a0cb976df",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "Respiratory rate"
        } ],
        "text": "Respiratory rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 15,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-dabf-2544d5ee0046",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-dabf-2544d5ee0046",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6690-2",
          "display": "Leukocytes [#/volume] in Blood by Automated count"
        } ],
        "text": "Leukocytes [#/volume] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 9.7937,
        "unit": "10*3/uL",
        "system": "http://unitsofmeasure.org",
        "code": "10*3/uL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7423-e2594c5db8f4",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-7423-e2594c5db8f4",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "789-8",
          "display": "Erythrocytes [#/volume] in Blood by Automated count"
        } ],
        "text": "Erythrocytes [#/volume] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 5.3383,
        "unit": "10*6/uL",
        "system": "http://unitsofmeasure.org",
        "code": "10*6/uL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a55c-d7d5389b0b1e",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-a55c-d7d5389b0b1e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "718-7",
          "display": "Hemoglobin [Mass/volume] in Blood"
        } ],
        "text": "Hemoglobin [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 16.464,
        "unit": "g/dL",
        "system": "http://unitsofmeasure.org",
        "code": "g/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-16ef-cd9e60b86b4c",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-16ef-cd9e60b86b4c",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "4544-3",
          "display": "Hematocrit [Volume Fraction] of Blood by Automated count"
        } ],
        "text": "Hematocrit [Volume Fraction] of Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 38.625,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9252-15761d2ce24c",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-9252-15761d2ce24c",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "787-2",
          "display": "MCV [Entitic mean volume] in Red Blood Cells by Automated count"
        } ],
        "text": "MCV [Entitic mean volume] in Red Blood Cells by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 90.905,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c8a4-e4802d22c269",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-c8a4-e4802d22c269",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "785-6",
          "display": "MCH [Entitic mass] by Automated count"
        } ],
        "text": "MCH [Entitic mass] by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 28.394,
        "unit": "pg",
        "system": "http://unitsofmeasure.org",
        "code": "pg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-291f-410355dffbdd",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-291f-410355dffbdd",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "786-4",
          "display": "MCHC [Entitic Mass/volume] in Red Blood Cells by Automated count"
        } ],
        "text": "MCHC [Entitic Mass/volume] in Red Blood Cells by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 34.201,
        "unit": "g/dL",
        "system": "http://unitsofmeasure.org",
        "code": "g/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6702-886e1ffac483",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-6702-886e1ffac483",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "788-0",
          "display": "Erythrocyte [DistWidth] in Blood by Automated count"
        } ],
        "text": "Erythrocyte [DistWidth] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 43.243,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0142-d19b710486d0",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-0142-d19b710486d0",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "777-3",
          "display": "Platelets [#/volume] in Blood by Automated count"
        } ],
        "text": "Platelets [#/volume] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 306.48,
        "unit": "10*3/uL",
        "system": "http://unitsofmeasure.org",
        "code": "10*3/uL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-40dc-af56ac804c04",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-40dc-af56ac804c04",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "32207-3",
          "display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
        } ],
        "text": "Platelet distribution width [Entitic volume] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 16.956,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ba66-1721c299159c",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-ba66-1721c299159c",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "32623-1",
          "display": "Platelet [Entitic mean volume] in Blood by Automated count"
        } ],
        "text": "Platelet [Entitic mean volume] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 10.769,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7400-7032215fda0a",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-7400-7032215fda0a",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72166-2",
          "display": "Tobacco smoking status"
        } ],
        "text": "Tobacco smoking status"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "266919005",
          "display": "Never smoked tobacco (finding)"
        } ],
        "text": "Never smoked tobacco (finding)"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-efd9-4335bda5602b",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-efd9-4335bda5602b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "430193006",
          "display": "Medication reconciliation (procedure)"
        } ],
        "text": "Medication reconciliation (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "performedPeriod": {
        "start": "2017-05-06T03:16:29+00:00",
        "end": "2017-05-06T03:31:29+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3c6d-2e9941dde835",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-3c6d-2e9941dde835",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "103697008",
          "display": "Patient referral for dental care (procedure)"
        } ],
        "text": "Patient referral for dental care (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "performedPeriod": {
        "start": "2017-05-06T03:16:29+00:00",
        "end": "2017-05-06T03:26:44+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-1998-97036b49fb93",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-1998-97036b49fb93",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "115",
          "display": "Tdap"
        } ],
        "text": "Tdap"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "date": "2017-05-06T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b74f-745c1b0370fd",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-b74f-745c1b0370fd",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "140",
          "display": "Influenza, split virus, trivalent, PF"
        } ],
        "text": "Influenza, split virus, trivalent, PF"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "date": "2017-05-06T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7818-43db2fbb94ee",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-7818-43db2fbb94ee",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "62",
          "display": "HPV, quadrivalent"
        } ],
        "text": "HPV, quadrivalent"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "date": "2017-05-06T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-be45-f3a9931ef38e",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-be45-f3a9931ef38e",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "114",
          "display": "meningococcal MCV4P"
        } ],
        "text": "meningococcal MCV4P"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "date": "2017-05-06T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-2706-e06d79e06246",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-2706-e06d79e06246",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "58410-2",
          "display": "CBC panel - Blood by Automated count"
        } ],
        "text": "CBC panel - Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
      },
      "effectiveDateTime": "2017-05-06T03:16:29+00:00",
      "issued": "2017-05-06T03:16:29.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-dabf-2544d5ee0046",
        "display": "Leukocytes [#/volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-7423-e2594c5db8f4",
        "display": "Erythrocytes [#/volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a55c-d7d5389b0b1e",
        "display": "Hemoglobin [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-16ef-cd9e60b86b4c",
        "display": "Hematocrit [Volume Fraction] of Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9252-15761d2ce24c",
        "display": "MCV [Entitic mean volume] in Red Blood Cells by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c8a4-e4802d22c269",
        "display": "MCH [Entitic mass] by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-291f-410355dffbdd",
        "display": "MCHC [Entitic Mass/volume] in Red Blood Cells by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-6702-886e1ffac483",
        "display": "Erythrocyte [DistWidth] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0142-d19b710486d0",
        "display": "Platelets [#/volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-40dc-af56ac804c04",
        "display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-ba66-1721c299159c",
        "display": "Platelet [Entitic mean volume] in Blood by Automated count"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0639-0ca38487d55c",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-0639-0ca38487d55c",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2017-05-06T03:16:29+00:00",
        "end": "2017-05-06T03:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-1998-97036b49fb93"
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-b74f-745c1b0370fd"
        }
      }, {
        "sequence": 3,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-7818-43db2fbb94ee"
        }
      }, {
        "sequence": 4,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-be45-f3a9931ef38e"
        }
      }, {
        "sequence": 5,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-efd9-4335bda5602b"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-3c6d-2e9941dde835"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-8916-f79292bdb9ee"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "informationLinkId": [ 4 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "net": {
          "value": 215.70,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "informationLinkId": [ 5 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "procedureLinkId": [ 2 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "103697008"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 1402.48,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:d74040ab-2e9d-2670-bea2-48162e424c9f",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "d74040ab-2e9d-2670-bea2-48162e424c9f",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-0639-0ca38487d55c"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2017-05-06T03:31:29+00:00",
        "end": "2018-05-06T03:31:29+00:00"
      },
      "provider": {
        "identifier": {
          "value": "2e3b72c0-7af9-3c34-a705-d894aacce6ac"
        }
      },
      "organization": {
        "identifier": {
          "value": "6f90eaad-abe3-3ce0-b9a6-2031c5674f0d"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999943696"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.360000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 109.44000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 5,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 6,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 43.14,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 172.56,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 215.70,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 215.70,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 7,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 8,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "103697008"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 1402.48,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 1121.984,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-a5b7-869cec8e93a1",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "185349003",
          "display": "Encounter for check up (procedure)"
        } ],
        "text": "Encounter for check up (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2017-05-13T03:16:29+00:00",
        "end": "2017-05-13T07:42:29+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "103697008",
          "display": "Patient referral for dental care (procedure)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-1ee1-be003c0e3c6e",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-1ee1-be003c0e3c6e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "34043003",
          "display": "Dental consultation and report (procedure)"
        } ],
        "text": "Dental consultation and report (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1"
      },
      "performedPeriod": {
        "start": "2017-05-13T03:16:29+00:00",
        "end": "2017-05-13T04:08:40+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7929-a1e00650a6cb",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-7929-a1e00650a6cb",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225362009",
          "display": "Dental care (regime/therapy)"
        } ],
        "text": "Dental care (regime/therapy)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1"
      },
      "performedPeriod": {
        "start": "2017-05-13T04:08:40+00:00",
        "end": "2017-05-13T04:36:15+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-123a-4048467db4cd",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-123a-4048467db4cd",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "1260009003",
          "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)"
        } ],
        "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1"
      },
      "performedPeriod": {
        "start": "2017-05-13T04:36:15+00:00",
        "end": "2017-05-13T05:18:34+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-bb15-6ef610c4ea69",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-bb15-6ef610c4ea69",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "1260010008",
          "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)"
        } ],
        "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1"
      },
      "performedPeriod": {
        "start": "2017-05-13T05:18:34+00:00",
        "end": "2017-05-13T05:49:00+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-38e7-38c623a63b7a",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-38e7-38c623a63b7a",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274788003",
          "display": "Examination of gingivae (procedure)"
        } ],
        "text": "Examination of gingivae (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1"
      },
      "performedPeriod": {
        "start": "2017-05-13T05:49:00+00:00",
        "end": "2017-05-13T06:46:15+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-744a-9418de6efaec",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-744a-9418de6efaec",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "68071007",
          "display": "Dental fluoride treatment (procedure)"
        } ],
        "text": "Dental fluoride treatment (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1"
      },
      "performedPeriod": {
        "start": "2017-05-13T06:46:15+00:00",
        "end": "2017-05-13T07:17:17+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-34f6-ce9aeed88931",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-34f6-ce9aeed88931",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "243085009",
          "display": "Oral health education (procedure)"
        } ],
        "text": "Oral health education (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1"
      },
      "performedPeriod": {
        "start": "2017-05-13T07:17:17+00:00",
        "end": "2017-05-13T07:42:29+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-990a-ee0fc56f0933",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "a00b5c95-fed5-f472-990a-ee0fc56f0933",
      "status": "completed",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "1535362",
          "display": "sodium fluoride 0.0272 MG/MG Oral Gel"
        } ],
        "text": "sodium fluoride 0.0272 MG/MG Oral Gel"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1"
      },
      "authoredOn": "2017-05-13T06:46:15+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
          "display": "LAWRENCE GENERAL HOSPITAL"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e97a-986a71faa1d2",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-e97a-986a71faa1d2",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2017-05-13T03:16:29+00:00",
        "end": "2017-05-13T07:42:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "prescription": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-990a-ee0fc56f0933"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1"
        } ]
      } ],
      "total": {
        "value": 129.94,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:7ecfe613-c6f4-3cb5-ff3e-1a531ef165e6",
    "resource": {
      "resourceType": "MedicationAdministration",
      "id": "7ecfe613-c6f4-3cb5-ff3e-1a531ef165e6",
      "status": "completed",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "1535362",
          "display": "sodium fluoride 0.0272 MG/MG Oral Gel"
        } ],
        "text": "sodium fluoride 0.0272 MG/MG Oral Gel"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1"
      },
      "effectiveDateTime": "2017-05-13T06:46:15+00:00"
    },
    "request": {
      "method": "POST",
      "url": "MedicationAdministration"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8b7a-14458063721c",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "a00b5c95-fed5-f472-8b7a-14458063721c",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 1
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "277183007",
            "display": "Dental equipment (physical object)"
          } ],
          "text": "Dental equipment (physical object)"
        }
      },
      "occurrenceDateTime": "2017-05-13T04:36:15+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b2c5-4355c1a9a25b",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "a00b5c95-fed5-f472-b2c5-4355c1a9a25b",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 1
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "1230220004",
            "display": "Conventional release periodontal gel (dose form)"
          } ],
          "text": "Conventional release periodontal gel (dose form)"
        }
      },
      "occurrenceDateTime": "2017-05-13T04:36:15+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4195-3e0298836901",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "a00b5c95-fed5-f472-4195-3e0298836901",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 1
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "469020004",
            "display": "Dental floss (physical object)"
          } ],
          "text": "Dental floss (physical object)"
        }
      },
      "occurrenceDateTime": "2017-05-13T04:36:15+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-f98d-b9c19a13a072",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-f98d-b9c19a13a072",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2017-05-13T03:16:29+00:00",
        "end": "2017-05-13T07:42:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 3,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-1ee1-be003c0e3c6e"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-7929-a1e00650a6cb"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-123a-4048467db4cd"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-bb15-6ef610c4ea69"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-38e7-38c623a63b7a"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-744a-9418de6efaec"
        }
      }, {
        "sequence": 7,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-34f6-ce9aeed88931"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-a5b7-869cec8e93a1"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "34043003"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "procedureLinkId": [ 2 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "225362009"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "procedureLinkId": [ 3 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "1260009003"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "procedureLinkId": [ 4 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "1260010008"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 9,
        "procedureLinkId": [ 5 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "274788003"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 10,
        "procedureLinkId": [ 6 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "68071007"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 11,
        "procedureLinkId": [ 7 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "243085009"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 3105.35,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:85046fd4-f8b8-97c1-6818-2154cb4bafc5",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "85046fd4-f8b8-97c1-6818-2154cb4bafc5",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-f98d-b9c19a13a072"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2017-05-13T07:42:29+00:00",
        "end": "2018-05-13T07:42:29+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 17.11,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 68.44,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "34043003"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "225362009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 5,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 6,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 7,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "1260009003"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 8,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "1260010008"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 9,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "274788003"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 10,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "68071007"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 11,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "243085009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 3105.35,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 2484.2799999999997,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0297-8e813f172232",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-0297-8e813f172232",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "185345009",
          "display": "Encounter for symptom (procedure)"
        } ],
        "text": "Encounter for symptom (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2017-12-19T09:16:29+00:00",
        "end": "2017-12-19T09:31:29+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "43878008",
          "display": "Streptococcal sore throat (disorder)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-cace-b817e6efab8d",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-cace-b817e6efab8d",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "43878008",
          "display": "Streptococcal sore throat (disorder)"
        } ],
        "text": "Streptococcal sore throat (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0297-8e813f172232"
      },
      "onsetDateTime": "2017-12-19T09:16:29+00:00",
      "abatementDateTime": "2017-12-31T23:16:29+00:00",
      "assertedDate": "2017-12-19T09:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d741-532b6e20af83",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-d741-532b6e20af83",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "Body temperature"
        } ],
        "text": "Body temperature"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0297-8e813f172232"
      },
      "effectiveDateTime": "2017-12-19T09:16:29+00:00",
      "issued": "2017-12-19T09:16:29.663+00:00",
      "valueQuantity": {
        "value": 39.353,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0b4b-e59cbc4200d6",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "a00b5c95-fed5-f472-0b4b-e59cbc4200d6",
      "status": "completed",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "834061",
          "display": "Penicillin V Potassium 250 MG Oral Tablet"
        } ],
        "text": "Penicillin V Potassium 250 MG Oral Tablet"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0297-8e813f172232"
      },
      "authoredOn": "2017-12-19T09:16:29+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
          "display": "LAWRENCE GENERAL HOSPITAL"
        }
      },
      "reasonReference": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-cace-b817e6efab8d"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-f74c-b630a9ec055c",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-f74c-b630a9ec055c",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2017-12-19T09:16:29+00:00",
        "end": "2017-12-19T09:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "prescription": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0b4b-e59cbc4200d6"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0297-8e813f172232"
        } ]
      } ],
      "total": {
        "value": 49.81,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8fb5-f6cd4c2995db",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-8fb5-f6cd4c2995db",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2017-12-19T09:16:29+00:00",
        "end": "2017-12-19T09:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-cace-b817e6efab8d"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0297-8e813f172232"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      } ],
      "total": {
        "value": 85.55,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:4761af55-ed0b-acdf-b34e-0f4a91d61c18",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "4761af55-ed0b-acdf-b34e-0f4a91d61c18",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-8fb5-f6cd4c2995db"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2017-12-19T09:31:29+00:00",
        "end": "2018-12-19T09:31:29+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-cace-b817e6efab8d"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 17.11,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 68.44,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        }
      } ],
      "totalCost": {
        "value": 85.55,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 68.44,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-2258-6630becdccaf",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "410620009",
          "display": "Well child visit (procedure)"
        } ],
        "text": "Well child visit (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999943696",
          "display": "Dr. Claribel706 Wuckert783"
        }
      } ],
      "period": {
        "start": "2018-05-12T03:16:29+00:00",
        "end": "2018-05-12T03:42:37+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0225-2e14ee91937e",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-0225-2e14ee91937e",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "314529007",
          "display": "Medication review due (situation)"
        } ],
        "text": "Medication review due (situation)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "onsetDateTime": "2018-05-12T03:16:29+00:00",
      "abatementDateTime": "2019-05-18T03:16:29+00:00",
      "assertedDate": "2018-05-12T03:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d2bc-3399539f9bc5",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-d2bc-3399539f9bc5",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "160968000",
          "display": "Risk activity involvement (finding)"
        } ],
        "text": "Risk activity involvement (finding)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "onsetDateTime": "2018-05-12T04:53:29+00:00",
      "abatementDateTime": "2019-05-18T04:50:31+00:00",
      "assertedDate": "2018-05-12T04:53:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4c2d-bb596f15f982",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-4c2d-bb596f15f982",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "Body Height"
        } ],
        "text": "Body Height"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T03:16:29+00:00",
      "issued": "2018-05-12T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 153.70,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3ba1-9188e6a5dad3",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-3ba1-9188e6a5dad3",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72514-3",
          "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
        } ],
        "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T03:16:29+00:00",
      "issued": "2018-05-12T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 1,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-37f0-6ae98178ed60",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-37f0-6ae98178ed60",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "29463-7",
          "display": "Body Weight"
        } ],
        "text": "Body Weight"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T03:16:29+00:00",
      "issued": "2018-05-12T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 44,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0751-7243b22835bd",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-0751-7243b22835bd",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "Body mass index (BMI) [Ratio]"
        } ],
        "text": "Body mass index (BMI) [Ratio]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T03:16:29+00:00",
      "issued": "2018-05-12T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 18.610,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-2908-b4d5ec3896ba",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-2908-b4d5ec3896ba",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "59576-9",
          "display": "Body mass index (BMI) [Percentile] Per age and sex"
        } ],
        "text": "Body mass index (BMI) [Percentile] Per age and sex"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T03:16:29+00:00",
      "issued": "2018-05-12T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 62.361,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b9be-4a77314fa5bc",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-b9be-4a77314fa5bc",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "85354-9",
          "display": "Blood pressure panel with all children optional"
        } ],
        "text": "Blood pressure panel with all children optional"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T03:16:29+00:00",
      "issued": "2018-05-12T03:16:29.663+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 75,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic Blood Pressure"
          } ],
          "text": "Systolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 132,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ba9c-1586eb10b1d6",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-ba9c-1586eb10b1d6",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "Heart rate"
        } ],
        "text": "Heart rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T03:16:29+00:00",
      "issued": "2018-05-12T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 93,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d581-3641dfff5290",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-d581-3641dfff5290",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "Respiratory rate"
        } ],
        "text": "Respiratory rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T03:16:29+00:00",
      "issued": "2018-05-12T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 15,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-58d1-00e7ba757249",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-58d1-00e7ba757249",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72166-2",
          "display": "Tobacco smoking status"
        } ],
        "text": "Tobacco smoking status"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T03:16:29+00:00",
      "issued": "2018-05-12T03:16:29.663+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "266919005",
          "display": "Never smoked tobacco (finding)"
        } ],
        "text": "Never smoked tobacco (finding)"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0adb-00facd37c007",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-0adb-00facd37c007",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "70274-6",
          "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
        } ],
        "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T03:42:37+00:00",
      "issued": "2018-05-12T03:42:37.663+00:00",
      "valueQuantity": {
        "value": 2,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-fa9e-383803c21b9e",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-fa9e-383803c21b9e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "89204-2",
          "display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
        } ],
        "text": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T04:22:02+00:00",
      "issued": "2018-05-12T04:22:02.663+00:00",
      "valueQuantity": {
        "value": 0,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a43a-7187956914d3",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-a43a-7187956914d3",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "710841007",
          "display": "Assessment of anxiety (procedure)"
        } ],
        "text": "Assessment of anxiety (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "performedPeriod": {
        "start": "2018-05-12T03:16:29+00:00",
        "end": "2018-05-12T03:42:37+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9120-ff00e174c3ac",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-9120-ff00e174c3ac",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "performedPeriod": {
        "start": "2018-05-12T03:42:37+00:00",
        "end": "2018-05-12T03:57:03+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a9ea-11881bf855e8",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-a9ea-11881bf855e8",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "715252007",
          "display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
        } ],
        "text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "performedPeriod": {
        "start": "2018-05-12T03:57:03+00:00",
        "end": "2018-05-12T04:22:02+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c1b4-99cc31d09d02",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-c1b4-99cc31d09d02",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "428211000124100",
          "display": "Assessment of substance use (procedure)"
        } ],
        "text": "Assessment of substance use (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "performedPeriod": {
        "start": "2018-05-12T04:22:02+00:00",
        "end": "2018-05-12T04:32:45+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a615-600bf3989ee1",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-a615-600bf3989ee1",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "868187001",
          "display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
        } ],
        "text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "performedPeriod": {
        "start": "2018-05-12T04:32:45+00:00",
        "end": "2018-05-12T04:53:29+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c03a-fdad19d7a9ee",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-c03a-fdad19d7a9ee",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "370995009",
          "display": "Health risks education (procedure)"
        } ],
        "text": "Health risks education (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "performedPeriod": {
        "start": "2018-05-12T04:53:29+00:00",
        "end": "2018-05-12T05:12:27+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d2bc-3399539f9bc5",
        "display": "Risk activity involvement (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3a01-efac528112cc",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-3a01-efac528112cc",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "140",
          "display": "Influenza, split virus, trivalent, PF"
        } ],
        "text": "Influenza, split virus, trivalent, PF"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "date": "2018-05-12T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0c48-5db3510ce19e",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-0c48-5db3510ce19e",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "62",
          "display": "HPV, quadrivalent"
        } ],
        "text": "HPV, quadrivalent"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "date": "2018-05-12T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-514a-7e34619a0fc4",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-514a-7e34619a0fc4",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "69737-5",
          "display": "Generalized anxiety disorder 7 item (GAD-7)"
        } ],
        "text": "Generalized anxiety disorder 7 item (GAD-7)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T03:42:37+00:00",
      "issued": "2018-05-12T03:42:37.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0adb-00facd37c007",
        "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a3d8-658cb4371b01",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-a3d8-658cb4371b01",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "89206-7",
          "display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
        } ],
        "text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
      },
      "effectiveDateTime": "2018-05-12T04:22:02+00:00",
      "issued": "2018-05-12T04:22:02.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-fa9e-383803c21b9e",
        "display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8b32-12f8f1c7cef8",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-8b32-12f8f1c7cef8",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2018-05-12T03:16:29+00:00",
        "end": "2018-05-12T03:42:37+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-3a01-efac528112cc"
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0c48-5db3510ce19e"
        }
      }, {
        "sequence": 3,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 4,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0225-2e14ee91937e"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-d2bc-3399539f9bc5"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-a43a-7187956914d3"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-9120-ff00e174c3ac"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-a9ea-11881bf855e8"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c1b4-99cc31d09d02"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-a615-600bf3989ee1"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c03a-fdad19d7a9ee"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-2258-6630becdccaf"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 5,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710841007"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "procedureLinkId": [ 2 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "procedureLinkId": [ 3 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "715252007"
          } ]
        },
        "net": {
          "value": 25.88,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 9,
        "informationLinkId": [ 4 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 10,
        "procedureLinkId": [ 4 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "428211000124100"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 11,
        "procedureLinkId": [ 5 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "868187001"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 12,
        "diagnosisLinkId": [ 2 ]
      }, {
        "sequence": 13,
        "procedureLinkId": [ 6 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "370995009"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 2740.84,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:49233801-ad97-ca45-ddbc-e27220357643",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "49233801-ad97-ca45-ddbc-e27220357643",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-8b32-12f8f1c7cef8"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2018-05-12T03:42:37+00:00",
        "end": "2019-05-12T03:42:37+00:00"
      },
      "provider": {
        "identifier": {
          "value": "2e3b72c0-7af9-3c34-a705-d894aacce6ac"
        }
      },
      "organization": {
        "identifier": {
          "value": "6f90eaad-abe3-3ce0-b9a6-2031c5674f0d"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999943696"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0225-2e14ee91937e"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-d2bc-3399539f9bc5"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.360000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 109.44000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 5,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710841007"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 6,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 7,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 8,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "715252007"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 5.176,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 20.704,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 25.88,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 25.88,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 9,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 10,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "428211000124100"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 11,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "868187001"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 12,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 13,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "370995009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 840.20,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 2192.6719999999996,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-d95e-085b7d218865",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "410620009",
          "display": "Well child visit (procedure)"
        } ],
        "text": "Well child visit (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999943696",
          "display": "Dr. Claribel706 Wuckert783"
        }
      } ],
      "period": {
        "start": "2019-05-18T03:16:29+00:00",
        "end": "2019-05-18T03:45:07+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-bdbc-9665b8b4e22b",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-bdbc-9665b8b4e22b",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "Body Height"
        } ],
        "text": "Body Height"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T03:16:29+00:00",
      "issued": "2019-05-18T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 161,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-162b-dfe60fc496a7",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-162b-dfe60fc496a7",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72514-3",
          "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
        } ],
        "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T03:16:29+00:00",
      "issued": "2019-05-18T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 0,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4169-cefce02486f5",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-4169-cefce02486f5",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "29463-7",
          "display": "Body Weight"
        } ],
        "text": "Body Weight"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T03:16:29+00:00",
      "issued": "2019-05-18T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 52.100,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a338-0e90a2acbc72",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-a338-0e90a2acbc72",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "Body mass index (BMI) [Ratio]"
        } ],
        "text": "Body mass index (BMI) [Ratio]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T03:16:29+00:00",
      "issued": "2019-05-18T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 20.100,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6b05-4bff112f8ac7",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-6b05-4bff112f8ac7",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "59576-9",
          "display": "Body mass index (BMI) [Percentile] Per age and sex"
        } ],
        "text": "Body mass index (BMI) [Percentile] Per age and sex"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T03:16:29+00:00",
      "issued": "2019-05-18T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 71.655,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-329b-fa6481ba3d64",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-329b-fa6481ba3d64",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "85354-9",
          "display": "Blood pressure panel with all children optional"
        } ],
        "text": "Blood pressure panel with all children optional"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T03:16:29+00:00",
      "issued": "2019-05-18T03:16:29.663+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 76,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic Blood Pressure"
          } ],
          "text": "Systolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 121,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4132-db9421f6740c",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-4132-db9421f6740c",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "Heart rate"
        } ],
        "text": "Heart rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T03:16:29+00:00",
      "issued": "2019-05-18T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 68,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-eb83-f6911590f3c5",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-eb83-f6911590f3c5",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "Respiratory rate"
        } ],
        "text": "Respiratory rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T03:16:29+00:00",
      "issued": "2019-05-18T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 15,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-dcec-64995b03f4f4",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-dcec-64995b03f4f4",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72166-2",
          "display": "Tobacco smoking status"
        } ],
        "text": "Tobacco smoking status"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T03:16:29+00:00",
      "issued": "2019-05-18T03:16:29.663+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "266919005",
          "display": "Never smoked tobacco (finding)"
        } ],
        "text": "Never smoked tobacco (finding)"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8599-2666d1fcf950",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-8599-2666d1fcf950",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "70274-6",
          "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
        } ],
        "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T03:45:07+00:00",
      "issued": "2019-05-18T03:45:07.663+00:00",
      "valueQuantity": {
        "value": 2,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-fa7c-2fffd3aa56d6",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-fa7c-2fffd3aa56d6",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "89204-2",
          "display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
        } ],
        "text": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T04:24:06+00:00",
      "issued": "2019-05-18T04:24:06.663+00:00",
      "valueQuantity": {
        "value": 1,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0392-c7a172cf2664",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-0392-c7a172cf2664",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "430193006",
          "display": "Medication reconciliation (procedure)"
        } ],
        "text": "Medication reconciliation (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "performedPeriod": {
        "start": "2019-05-18T03:16:29+00:00",
        "end": "2019-05-18T03:31:29+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-61b7-48df51242b28",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-61b7-48df51242b28",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "710841007",
          "display": "Assessment of anxiety (procedure)"
        } ],
        "text": "Assessment of anxiety (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "performedPeriod": {
        "start": "2019-05-18T03:16:29+00:00",
        "end": "2019-05-18T03:45:07+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-87d0-e9e89e01970b",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-87d0-e9e89e01970b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "performedPeriod": {
        "start": "2019-05-18T03:45:07+00:00",
        "end": "2019-05-18T03:57:15+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4679-a62dc4b72e75",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-4679-a62dc4b72e75",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "715252007",
          "display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
        } ],
        "text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "performedPeriod": {
        "start": "2019-05-18T03:57:15+00:00",
        "end": "2019-05-18T04:24:06+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e0f1-f3a0e5cf2552",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-e0f1-f3a0e5cf2552",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "428211000124100",
          "display": "Assessment of substance use (procedure)"
        } ],
        "text": "Assessment of substance use (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "performedPeriod": {
        "start": "2019-05-18T04:24:06+00:00",
        "end": "2019-05-18T04:34:08+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-45cf-1bcca47a0dd8",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-45cf-1bcca47a0dd8",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "868187001",
          "display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
        } ],
        "text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "performedPeriod": {
        "start": "2019-05-18T04:34:08+00:00",
        "end": "2019-05-18T04:50:31+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3148-3853adf30c69",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-3148-3853adf30c69",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "386516004",
          "display": "Anticipatory guidance (procedure)"
        } ],
        "text": "Anticipatory guidance (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "performedPeriod": {
        "start": "2019-05-18T04:50:31+00:00",
        "end": "2019-05-18T04:55:34+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-08c0-54555259ab5b",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-08c0-54555259ab5b",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "140",
          "display": "Influenza, split virus, trivalent, PF"
        } ],
        "text": "Influenza, split virus, trivalent, PF"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "date": "2019-05-18T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5acd-f1bef2b098ad",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-5acd-f1bef2b098ad",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "62",
          "display": "HPV, quadrivalent"
        } ],
        "text": "HPV, quadrivalent"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "date": "2019-05-18T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6097-381d4474a3c8",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-6097-381d4474a3c8",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "69737-5",
          "display": "Generalized anxiety disorder 7 item (GAD-7)"
        } ],
        "text": "Generalized anxiety disorder 7 item (GAD-7)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T03:45:07+00:00",
      "issued": "2019-05-18T03:45:07.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8599-2666d1fcf950",
        "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d8f8-96a3aefaa904",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-d8f8-96a3aefaa904",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "89206-7",
          "display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
        } ],
        "text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
      },
      "effectiveDateTime": "2019-05-18T04:24:06+00:00",
      "issued": "2019-05-18T04:24:06.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-fa7c-2fffd3aa56d6",
        "display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0f63-47a355048102",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-0f63-47a355048102",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2019-05-18T03:16:29+00:00",
        "end": "2019-05-18T03:45:07+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-08c0-54555259ab5b"
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-5acd-f1bef2b098ad"
        }
      }, {
        "sequence": 3,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 4,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0392-c7a172cf2664"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-61b7-48df51242b28"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-87d0-e9e89e01970b"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-4679-a62dc4b72e75"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-e0f1-f3a0e5cf2552"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-45cf-1bcca47a0dd8"
        }
      }, {
        "sequence": 7,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-3148-3853adf30c69"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-d95e-085b7d218865"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "net": {
          "value": 545.30,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "procedureLinkId": [ 2 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710841007"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "procedureLinkId": [ 3 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "procedureLinkId": [ 4 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "715252007"
          } ]
        },
        "net": {
          "value": 34.51,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 9,
        "informationLinkId": [ 4 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 10,
        "procedureLinkId": [ 5 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "428211000124100"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 11,
        "procedureLinkId": [ 6 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "868187001"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 12,
        "procedureLinkId": [ 7 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "386516004"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 3294.77,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:c3373eed-3884-57e0-0ce0-d3230a5f17ca",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "c3373eed-3884-57e0-0ce0-d3230a5f17ca",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-0f63-47a355048102"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2019-05-18T03:45:07+00:00",
        "end": "2020-05-18T03:45:07+00:00"
      },
      "provider": {
        "identifier": {
          "value": "2e3b72c0-7af9-3c34-a705-d894aacce6ac"
        }
      },
      "organization": {
        "identifier": {
          "value": "6f90eaad-abe3-3ce0-b9a6-2031c5674f0d"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999943696"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.360000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 109.44000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 109.06,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 436.24,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 545.30,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 545.30,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 5,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710841007"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 6,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 7,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 8,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "715252007"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 6.902,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 27.608,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 34.51,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 34.51,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 9,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 10,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "428211000124100"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 11,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "868187001"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 12,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "386516004"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 1385.50,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 2635.816,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-c3ff-36dbf148a532",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "410620009",
          "display": "Well child visit (procedure)"
        } ],
        "text": "Well child visit (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999943696",
          "display": "Dr. Claribel706 Wuckert783"
        }
      } ],
      "period": {
        "start": "2020-05-23T03:16:29+00:00",
        "end": "2020-05-23T03:37:55+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c20f-b630bec4ff6b",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-c20f-b630bec4ff6b",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "314529007",
          "display": "Medication review due (situation)"
        } ],
        "text": "Medication review due (situation)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "onsetDateTime": "2020-05-23T03:16:29+00:00",
      "abatementDateTime": "2020-05-23T03:16:29+00:00",
      "assertedDate": "2020-05-23T03:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3fe2-6ae4d60f2214",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-3fe2-6ae4d60f2214",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "Body Height"
        } ],
        "text": "Body Height"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T03:16:29+00:00",
      "issued": "2020-05-23T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 169.40,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5c61-9fe2ef2e305e",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-5c61-9fe2ef2e305e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72514-3",
          "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
        } ],
        "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T03:16:29+00:00",
      "issued": "2020-05-23T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 4,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4193-c443c5eac225",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-4193-c443c5eac225",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "29463-7",
          "display": "Body Weight"
        } ],
        "text": "Body Weight"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T03:16:29+00:00",
      "issued": "2020-05-23T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 59.600,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9a4d-1cffc4648c79",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-9a4d-1cffc4648c79",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "Body mass index (BMI) [Ratio]"
        } ],
        "text": "Body mass index (BMI) [Ratio]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T03:16:29+00:00",
      "issued": "2020-05-23T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 20.770,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-188e-81d6937e94c3",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-188e-81d6937e94c3",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "59576-9",
          "display": "Body mass index (BMI) [Percentile] Per age and sex"
        } ],
        "text": "Body mass index (BMI) [Percentile] Per age and sex"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T03:16:29+00:00",
      "issued": "2020-05-23T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 70.146,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-efdf-33af21cd1dfe",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-efdf-33af21cd1dfe",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "85354-9",
          "display": "Blood pressure panel with all children optional"
        } ],
        "text": "Blood pressure panel with all children optional"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T03:16:29+00:00",
      "issued": "2020-05-23T03:16:29.663+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 74,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic Blood Pressure"
          } ],
          "text": "Systolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 129,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8345-01b1591e5700",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-8345-01b1591e5700",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "Heart rate"
        } ],
        "text": "Heart rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T03:16:29+00:00",
      "issued": "2020-05-23T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 79,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d1b5-41c494d1a2db",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-d1b5-41c494d1a2db",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "Respiratory rate"
        } ],
        "text": "Respiratory rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T03:16:29+00:00",
      "issued": "2020-05-23T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 13,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e282-ecbb9bd03e9b",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-e282-ecbb9bd03e9b",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72166-2",
          "display": "Tobacco smoking status"
        } ],
        "text": "Tobacco smoking status"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T03:16:29+00:00",
      "issued": "2020-05-23T03:16:29.663+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "266919005",
          "display": "Never smoked tobacco (finding)"
        } ],
        "text": "Never smoked tobacco (finding)"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ebf0-6b2fc25d9deb",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-ebf0-6b2fc25d9deb",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "70274-6",
          "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
        } ],
        "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T03:37:55+00:00",
      "issued": "2020-05-23T03:37:55.663+00:00",
      "valueQuantity": {
        "value": 3,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8899-2b49a67f6f67",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-8899-2b49a67f6f67",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "89204-2",
          "display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
        } ],
        "text": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T04:16:09+00:00",
      "issued": "2020-05-23T04:16:09.663+00:00",
      "valueQuantity": {
        "value": 1,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d858-695bf127fc08",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-d858-695bf127fc08",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "430193006",
          "display": "Medication reconciliation (procedure)"
        } ],
        "text": "Medication reconciliation (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "performedPeriod": {
        "start": "2020-05-23T03:16:29+00:00",
        "end": "2020-05-23T03:31:29+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3c01-9aae3666eb05",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-3c01-9aae3666eb05",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "710841007",
          "display": "Assessment of anxiety (procedure)"
        } ],
        "text": "Assessment of anxiety (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "performedPeriod": {
        "start": "2020-05-23T03:16:29+00:00",
        "end": "2020-05-23T03:37:55+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-f512-349673f35043",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-f512-349673f35043",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "performedPeriod": {
        "start": "2020-05-23T03:37:55+00:00",
        "end": "2020-05-23T03:51:23+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ccfb-ed26f460038b",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-ccfb-ed26f460038b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "715252007",
          "display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
        } ],
        "text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "performedPeriod": {
        "start": "2020-05-23T03:51:23+00:00",
        "end": "2020-05-23T04:16:09+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6cef-6dc1c319527a",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-6cef-6dc1c319527a",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "428211000124100",
          "display": "Assessment of substance use (procedure)"
        } ],
        "text": "Assessment of substance use (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "performedPeriod": {
        "start": "2020-05-23T04:16:09+00:00",
        "end": "2020-05-23T04:28:30+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e551-87dc8e2331ae",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-e551-87dc8e2331ae",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "868187001",
          "display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
        } ],
        "text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "performedPeriod": {
        "start": "2020-05-23T04:28:30+00:00",
        "end": "2020-05-23T04:48:13+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8992-28e321ce1f5f",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-8992-28e321ce1f5f",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "386516004",
          "display": "Anticipatory guidance (procedure)"
        } ],
        "text": "Anticipatory guidance (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "performedPeriod": {
        "start": "2020-05-23T04:48:13+00:00",
        "end": "2020-05-23T04:54:07+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9802-363838e2376e",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-9802-363838e2376e",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "140",
          "display": "Influenza, split virus, trivalent, PF"
        } ],
        "text": "Influenza, split virus, trivalent, PF"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "date": "2020-05-23T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-dea0-5cc19a2fe168",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-dea0-5cc19a2fe168",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "69737-5",
          "display": "Generalized anxiety disorder 7 item (GAD-7)"
        } ],
        "text": "Generalized anxiety disorder 7 item (GAD-7)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T03:37:55+00:00",
      "issued": "2020-05-23T03:37:55.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-ebf0-6b2fc25d9deb",
        "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-dffe-8977230e3dae",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-dffe-8977230e3dae",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "89206-7",
          "display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
        } ],
        "text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
      },
      "effectiveDateTime": "2020-05-23T04:16:09+00:00",
      "issued": "2020-05-23T04:16:09.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8899-2b49a67f6f67",
        "display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-38af-21a51506cdf9",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-38af-21a51506cdf9",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2020-05-23T03:16:29+00:00",
        "end": "2020-05-23T03:37:55+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-9802-363838e2376e"
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 3,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c20f-b630bec4ff6b"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-d858-695bf127fc08"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-3c01-9aae3666eb05"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-f512-349673f35043"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-ccfb-ed26f460038b"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-6cef-6dc1c319527a"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-e551-87dc8e2331ae"
        }
      }, {
        "sequence": 7,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-8992-28e321ce1f5f"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c3ff-36dbf148a532"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 4,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "net": {
          "value": 583.26,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "procedureLinkId": [ 2 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710841007"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "procedureLinkId": [ 3 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "procedureLinkId": [ 4 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "715252007"
          } ]
        },
        "net": {
          "value": 34.51,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 9,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 10,
        "procedureLinkId": [ 5 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "428211000124100"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 11,
        "procedureLinkId": [ 6 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "868187001"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 12,
        "procedureLinkId": [ 7 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "386516004"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 3196.73,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:270e5ec6-04c4-faa2-952e-b7e47b74f4f4",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "270e5ec6-04c4-faa2-952e-b7e47b74f4f4",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-38af-21a51506cdf9"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2020-05-23T03:37:55+00:00",
        "end": "2021-05-23T03:37:55+00:00"
      },
      "provider": {
        "identifier": {
          "value": "2e3b72c0-7af9-3c34-a705-d894aacce6ac"
        }
      },
      "organization": {
        "identifier": {
          "value": "6f90eaad-abe3-3ce0-b9a6-2031c5674f0d"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999943696"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c20f-b630bec4ff6b"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.360000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 109.44000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 116.652,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 466.608,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 583.26,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 583.26,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 5,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710841007"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 6,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 7,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 8,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "715252007"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 6.902,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 27.608,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 34.51,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 34.51,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 9,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 10,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "428211000124100"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 11,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "868187001"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 12,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "386516004"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 1287.46,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 2557.3839999999996,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-effa-8b7103594023",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "410620009",
          "display": "Well child visit (procedure)"
        } ],
        "text": "Well child visit (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999943696",
          "display": "Dr. Claribel706 Wuckert783"
        }
      } ],
      "period": {
        "start": "2021-05-29T03:16:29+00:00",
        "end": "2021-05-29T03:31:29+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-2ce4-b2c58eceac08",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-2ce4-b2c58eceac08",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "314529007",
          "display": "Medication review due (situation)"
        } ],
        "text": "Medication review due (situation)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "onsetDateTime": "2021-05-29T03:16:29+00:00",
      "abatementDateTime": "2021-05-29T03:16:29+00:00",
      "assertedDate": "2021-05-29T03:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-638b-d74a6953960f",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-638b-d74a6953960f",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "Body Height"
        } ],
        "text": "Body Height"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "effectiveDateTime": "2021-05-29T03:16:29+00:00",
      "issued": "2021-05-29T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 175,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-1a4c-26da178c425d",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-1a4c-26da178c425d",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72514-3",
          "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
        } ],
        "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "effectiveDateTime": "2021-05-29T03:16:29+00:00",
      "issued": "2021-05-29T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 0,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a6d9-bff4361d7e6e",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-a6d9-bff4361d7e6e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "29463-7",
          "display": "Body Weight"
        } ],
        "text": "Body Weight"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "effectiveDateTime": "2021-05-29T03:16:29+00:00",
      "issued": "2021-05-29T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 60.200,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-78ba-9d925e3870be",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-78ba-9d925e3870be",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "Body mass index (BMI) [Ratio]"
        } ],
        "text": "Body mass index (BMI) [Ratio]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "effectiveDateTime": "2021-05-29T03:16:29+00:00",
      "issued": "2021-05-29T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 19.680,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6425-2e24a334d816",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-6425-2e24a334d816",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "59576-9",
          "display": "Body mass index (BMI) [Percentile] Per age and sex"
        } ],
        "text": "Body mass index (BMI) [Percentile] Per age and sex"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "effectiveDateTime": "2021-05-29T03:16:29+00:00",
      "issued": "2021-05-29T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 46.360,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a509-98bafea0e220",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-a509-98bafea0e220",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "85354-9",
          "display": "Blood pressure panel with all children optional"
        } ],
        "text": "Blood pressure panel with all children optional"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "effectiveDateTime": "2021-05-29T03:16:29+00:00",
      "issued": "2021-05-29T03:16:29.663+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 75,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic Blood Pressure"
          } ],
          "text": "Systolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 123,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a1c3-a6718d4d6f1d",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-a1c3-a6718d4d6f1d",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "Heart rate"
        } ],
        "text": "Heart rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "effectiveDateTime": "2021-05-29T03:16:29+00:00",
      "issued": "2021-05-29T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 95,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-797b-4984563af257",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-797b-4984563af257",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "Respiratory rate"
        } ],
        "text": "Respiratory rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "effectiveDateTime": "2021-05-29T03:16:29+00:00",
      "issued": "2021-05-29T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 14,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-03f7-3eb5d39d53a0",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-03f7-3eb5d39d53a0",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72166-2",
          "display": "Tobacco smoking status"
        } ],
        "text": "Tobacco smoking status"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "effectiveDateTime": "2021-05-29T03:16:29+00:00",
      "issued": "2021-05-29T03:16:29.663+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "266919005",
          "display": "Never smoked tobacco (finding)"
        } ],
        "text": "Never smoked tobacco (finding)"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0836-b1f084913a8a",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-0836-b1f084913a8a",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "89204-2",
          "display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
        } ],
        "text": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "effectiveDateTime": "2021-05-29T03:55:01+00:00",
      "issued": "2021-05-29T03:55:01.663+00:00",
      "valueQuantity": {
        "value": 13,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4561-6442dcc535f8",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-4561-6442dcc535f8",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "430193006",
          "display": "Medication reconciliation (procedure)"
        } ],
        "text": "Medication reconciliation (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "performedPeriod": {
        "start": "2021-05-29T03:16:29+00:00",
        "end": "2021-05-29T03:31:29+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9eab-0042099aaaf6",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-9eab-0042099aaaf6",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "performedPeriod": {
        "start": "2021-05-29T03:16:29+00:00",
        "end": "2021-05-29T03:31:01+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-df1c-e3e6ca9b71d9",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-df1c-e3e6ca9b71d9",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "715252007",
          "display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
        } ],
        "text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "performedPeriod": {
        "start": "2021-05-29T03:31:01+00:00",
        "end": "2021-05-29T03:55:01+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ad41-08a8c3254bda",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-ad41-08a8c3254bda",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "140",
          "display": "Influenza, split virus, trivalent, PF"
        } ],
        "text": "Influenza, split virus, trivalent, PF"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "date": "2021-05-29T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-1cb4-4765630e49f9",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-1cb4-4765630e49f9",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "89206-7",
          "display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
        } ],
        "text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
      },
      "effectiveDateTime": "2021-05-29T03:55:01+00:00",
      "issued": "2021-05-29T03:55:01.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0836-b1f084913a8a",
        "display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-28e9-44d13c4c6f00",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-28e9-44d13c4c6f00",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2021-05-29T03:16:29+00:00",
        "end": "2021-05-29T03:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-ad41-08a8c3254bda"
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-2ce4-b2c58eceac08"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-4561-6442dcc535f8"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-9eab-0042099aaaf6"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-df1c-e3e6ca9b71d9"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-effa-8b7103594023"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 4,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "procedureLinkId": [ 2 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "procedureLinkId": [ 3 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "715252007"
          } ]
        },
        "net": {
          "value": 25.88,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 1667.46,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:0f08ceeb-c113-afaa-a297-ac1204c52f7c",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "0f08ceeb-c113-afaa-a297-ac1204c52f7c",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-28e9-44d13c4c6f00"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2021-05-29T03:31:29+00:00",
        "end": "2022-05-29T03:31:29+00:00"
      },
      "provider": {
        "identifier": {
          "value": "2e3b72c0-7af9-3c34-a705-d894aacce6ac"
        }
      },
      "organization": {
        "identifier": {
          "value": "6f90eaad-abe3-3ce0-b9a6-2031c5674f0d"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999943696"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-2ce4-b2c58eceac08"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.360000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 109.44000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 172.56,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 690.24,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 862.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 862.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 5,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 6,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "715252007"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 5.176,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 20.704,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 25.88,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 25.88,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 7,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 1567.00,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 1333.9679999999998,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e983-2f9a197d617c",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-e983-2f9a197d617c",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "33879002",
          "display": "Administration of vaccine to produce active immunity (procedure)"
        } ],
        "text": "Administration of vaccine to produce active immunity (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2021-07-31T03:16:29+00:00",
        "end": "2021-07-31T03:31:29+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ffd6-56ae699eb5e6",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-ffd6-56ae699eb5e6",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "208",
          "display": "COVID-19, mRNA, LNP-S, PF, 30 mcg/0.3 mL dose"
        } ],
        "text": "COVID-19, mRNA, LNP-S, PF, 30 mcg/0.3 mL dose"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-e983-2f9a197d617c"
      },
      "date": "2021-07-31T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ea57-0b977a991e71",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-ea57-0b977a991e71",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2021-07-31T03:16:29+00:00",
        "end": "2021-07-31T03:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-ffd6-56ae699eb5e6"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-e983-2f9a197d617c"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 278.58,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:b3f9e468-b862-4eab-6579-b6fc4c51377f",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "b3f9e468-b862-4eab-6579-b6fc4c51377f",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999995191"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-ea57-0b977a991e71"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2021-07-31T03:31:29+00:00",
        "end": "2022-07-31T03:31:29+00:00"
      },
      "created": "2021-07-31T03:31:29+00:00",
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-ea57-0b977a991e71"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2021-07-31T03:16:29+00:00",
          "end": "2021-07-31T03:31:29+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-e983-2f9a197d617c"
        } ],
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2021-07-31T03:16:29+00:00",
          "end": "2021-07-31T03:31:29+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 278.58,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 222.86400000000003,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8afe-e7334de13343",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-8afe-e7334de13343",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "33879002",
          "display": "Administration of vaccine to produce active immunity (procedure)"
        } ],
        "text": "Administration of vaccine to produce active immunity (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2021-08-21T03:16:29+00:00",
        "end": "2021-08-21T03:31:29+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-479e-4f75466ff296",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-479e-4f75466ff296",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "208",
          "display": "COVID-19, mRNA, LNP-S, PF, 30 mcg/0.3 mL dose"
        } ],
        "text": "COVID-19, mRNA, LNP-S, PF, 30 mcg/0.3 mL dose"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8afe-e7334de13343"
      },
      "date": "2021-08-21T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4c54-abe7c94523cd",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-4c54-abe7c94523cd",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2021-08-21T03:16:29+00:00",
        "end": "2021-08-21T03:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-479e-4f75466ff296"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-8afe-e7334de13343"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 278.58,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:0f57c5c7-75ba-724d-ff93-1dc49ef3cc44",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "0f57c5c7-75ba-724d-ff93-1dc49ef3cc44",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999995191"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-4c54-abe7c94523cd"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2021-08-21T03:31:29+00:00",
        "end": "2022-08-21T03:31:29+00:00"
      },
      "created": "2021-08-21T03:31:29+00:00",
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4c54-abe7c94523cd"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2021-08-21T03:16:29+00:00",
          "end": "2021-08-21T03:31:29+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-8afe-e7334de13343"
        } ],
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2021-08-21T03:16:29+00:00",
          "end": "2021-08-21T03:31:29+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 278.58,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 222.86400000000003,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-34b6-2196627b4815",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "410620009",
          "display": "Well child visit (procedure)"
        } ],
        "text": "Well child visit (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999943696",
          "display": "Dr. Claribel706 Wuckert783"
        }
      } ],
      "period": {
        "start": "2022-06-04T03:16:29+00:00",
        "end": "2022-06-04T03:31:29+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-26dc-b96569bfd053",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-26dc-b96569bfd053",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "314529007",
          "display": "Medication review due (situation)"
        } ],
        "text": "Medication review due (situation)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "onsetDateTime": "2022-06-04T03:16:29+00:00",
      "abatementDateTime": "2022-06-04T03:16:29+00:00",
      "assertedDate": "2022-06-04T03:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-23f0-7fad648efa0b",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-23f0-7fad648efa0b",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "Body Height"
        } ],
        "text": "Body Height"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 178.10,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-2842-228605785d1c",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-2842-228605785d1c",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72514-3",
          "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
        } ],
        "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 3,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3751-2cd9a585d3e6",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-3751-2cd9a585d3e6",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "29463-7",
          "display": "Body Weight"
        } ],
        "text": "Body Weight"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 62.300,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-78c7-c353d13d9838",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-78c7-c353d13d9838",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "Body mass index (BMI) [Ratio]"
        } ],
        "text": "Body mass index (BMI) [Ratio]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 19.640,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-07bd-19db34776e40",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-07bd-19db34776e40",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "59576-9",
          "display": "Body mass index (BMI) [Percentile] Per age and sex"
        } ],
        "text": "Body mass index (BMI) [Percentile] Per age and sex"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 35.150,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9158-858ae115ab01",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-9158-858ae115ab01",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "85354-9",
          "display": "Blood pressure panel with all children optional"
        } ],
        "text": "Blood pressure panel with all children optional"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 74,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic Blood Pressure"
          } ],
          "text": "Systolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 136,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-17e0-822564e121d6",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-17e0-822564e121d6",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "Heart rate"
        } ],
        "text": "Heart rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 94,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-fee3-5921d5ff6ac8",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-fee3-5921d5ff6ac8",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "Respiratory rate"
        } ],
        "text": "Respiratory rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 15,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7b01-cbbf1ad53cf6",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-7b01-cbbf1ad53cf6",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6690-2",
          "display": "Leukocytes [#/volume] in Blood by Automated count"
        } ],
        "text": "Leukocytes [#/volume] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 4.7030,
        "unit": "10*3/uL",
        "system": "http://unitsofmeasure.org",
        "code": "10*3/uL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6660-deb6ec9edb6d",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-6660-deb6ec9edb6d",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "789-8",
          "display": "Erythrocytes [#/volume] in Blood by Automated count"
        } ],
        "text": "Erythrocytes [#/volume] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 4.0631,
        "unit": "10*6/uL",
        "system": "http://unitsofmeasure.org",
        "code": "10*6/uL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7d7c-a26857189767",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-7d7c-a26857189767",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "718-7",
          "display": "Hemoglobin [Mass/volume] in Blood"
        } ],
        "text": "Hemoglobin [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 16.766,
        "unit": "g/dL",
        "system": "http://unitsofmeasure.org",
        "code": "g/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c736-fa9cb7ab2246",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-c736-fa9cb7ab2246",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "4544-3",
          "display": "Hematocrit [Volume Fraction] of Blood by Automated count"
        } ],
        "text": "Hematocrit [Volume Fraction] of Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 39.780,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-f5d8-a1fbbae43dfb",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-f5d8-a1fbbae43dfb",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "787-2",
          "display": "MCV [Entitic mean volume] in Red Blood Cells by Automated count"
        } ],
        "text": "MCV [Entitic mean volume] in Red Blood Cells by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 87.432,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-bc5a-70c2c81f8fab",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-bc5a-70c2c81f8fab",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "785-6",
          "display": "MCH [Entitic mass] by Automated count"
        } ],
        "text": "MCH [Entitic mass] by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 28.816,
        "unit": "pg",
        "system": "http://unitsofmeasure.org",
        "code": "pg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7c6f-dab33e17788f",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-7c6f-dab33e17788f",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "786-4",
          "display": "MCHC [Entitic Mass/volume] in Red Blood Cells by Automated count"
        } ],
        "text": "MCHC [Entitic Mass/volume] in Red Blood Cells by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 34.300,
        "unit": "g/dL",
        "system": "http://unitsofmeasure.org",
        "code": "g/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-cbe6-d84b7c30191b",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-cbe6-d84b7c30191b",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "788-0",
          "display": "Erythrocyte [DistWidth] in Blood by Automated count"
        } ],
        "text": "Erythrocyte [DistWidth] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 45.701,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-2880-af389ccce262",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-2880-af389ccce262",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "777-3",
          "display": "Platelets [#/volume] in Blood by Automated count"
        } ],
        "text": "Platelets [#/volume] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 385.42,
        "unit": "10*3/uL",
        "system": "http://unitsofmeasure.org",
        "code": "10*3/uL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-bbaa-4e0d0f2359b8",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-bbaa-4e0d0f2359b8",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "32207-3",
          "display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
        } ],
        "text": "Platelet distribution width [Entitic volume] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 14.064,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-32b2-2f2ee103f298",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-32b2-2f2ee103f298",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "32623-1",
          "display": "Platelet [Entitic mean volume] in Blood by Automated count"
        } ],
        "text": "Platelet [Entitic mean volume] in Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 10.718,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8784-f7129d3c22c8",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-8784-f7129d3c22c8",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72166-2",
          "display": "Tobacco smoking status"
        } ],
        "text": "Tobacco smoking status"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "449868002",
          "display": "Smokes tobacco daily (finding)"
        } ],
        "text": "Smokes tobacco daily (finding)"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-04a6-15516a60cd23",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-04a6-15516a60cd23",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "430193006",
          "display": "Medication reconciliation (procedure)"
        } ],
        "text": "Medication reconciliation (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "performedPeriod": {
        "start": "2022-06-04T03:16:29+00:00",
        "end": "2022-06-04T03:31:29+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-f059-cc869a81d76f",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-f059-cc869a81d76f",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "140",
          "display": "Influenza, split virus, trivalent, PF"
        } ],
        "text": "Influenza, split virus, trivalent, PF"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "date": "2022-06-04T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9698-4ba46ccf0fc2",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-9698-4ba46ccf0fc2",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "114",
          "display": "meningococcal MCV4P"
        } ],
        "text": "meningococcal MCV4P"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "date": "2022-06-04T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e44a-5e5ba3cd5849",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-e44a-5e5ba3cd5849",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "58410-2",
          "display": "CBC panel - Blood by Automated count"
        } ],
        "text": "CBC panel - Blood by Automated count"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
      },
      "effectiveDateTime": "2022-06-04T03:16:29+00:00",
      "issued": "2022-06-04T03:16:29.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-7b01-cbbf1ad53cf6",
        "display": "Leukocytes [#/volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-6660-deb6ec9edb6d",
        "display": "Erythrocytes [#/volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-7d7c-a26857189767",
        "display": "Hemoglobin [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c736-fa9cb7ab2246",
        "display": "Hematocrit [Volume Fraction] of Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f5d8-a1fbbae43dfb",
        "display": "MCV [Entitic mean volume] in Red Blood Cells by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-bc5a-70c2c81f8fab",
        "display": "MCH [Entitic mass] by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-7c6f-dab33e17788f",
        "display": "MCHC [Entitic Mass/volume] in Red Blood Cells by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-cbe6-d84b7c30191b",
        "display": "Erythrocyte [DistWidth] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2880-af389ccce262",
        "display": "Platelets [#/volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-bbaa-4e0d0f2359b8",
        "display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-32b2-2f2ee103f298",
        "display": "Platelet [Entitic mean volume] in Blood by Automated count"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-77fc-1eec8c8deaf6",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-77fc-1eec8c8deaf6",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2022-06-04T03:16:29+00:00",
        "end": "2022-06-04T03:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-f059-cc869a81d76f"
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-9698-4ba46ccf0fc2"
        }
      }, {
        "sequence": 3,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-26dc-b96569bfd053"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-04a6-15516a60cd23"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-34b6-2196627b4815"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 5,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 1346.18,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:2b768bae-6df8-79b0-201b-76dc4edd6610",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "2b768bae-6df8-79b0-201b-76dc4edd6610",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-77fc-1eec8c8deaf6"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2022-06-04T03:31:29+00:00",
        "end": "2023-06-04T03:31:29+00:00"
      },
      "provider": {
        "identifier": {
          "value": "2e3b72c0-7af9-3c34-a705-d894aacce6ac"
        }
      },
      "organization": {
        "identifier": {
          "value": "6f90eaad-abe3-3ce0-b9a6-2031c5674f0d"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999943696"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-26dc-b96569bfd053"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.360000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 109.44000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 5,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 172.56,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 690.24,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 862.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 862.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 6,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 1346.18,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 1076.944,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-d08b-70f5cee5ef6c",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "410620009",
          "display": "Well child visit (procedure)"
        } ],
        "text": "Well child visit (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999943696",
          "display": "Dr. Claribel706 Wuckert783"
        }
      } ],
      "period": {
        "start": "2023-06-10T03:16:29+00:00",
        "end": "2023-06-10T03:31:29+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-302f-dc055aa251a2",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-302f-dc055aa251a2",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "314529007",
          "display": "Medication review due (situation)"
        } ],
        "text": "Medication review due (situation)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "onsetDateTime": "2023-06-10T03:16:29+00:00",
      "abatementDateTime": "2023-06-10T03:16:29+00:00",
      "assertedDate": "2023-06-10T03:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-181c-6bfcf40bd6b1",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-181c-6bfcf40bd6b1",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "160968000",
          "display": "Risk activity involvement (finding)"
        } ],
        "text": "Risk activity involvement (finding)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "onsetDateTime": "2023-06-10T04:22:16+00:00",
      "assertedDate": "2023-06-10T04:22:16+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ea93-9f4bc735dcbc",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-ea93-9f4bc735dcbc",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "Body Height"
        } ],
        "text": "Body Height"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "effectiveDateTime": "2023-06-10T03:16:29+00:00",
      "issued": "2023-06-10T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 179.60,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5cf7-9f12661412a9",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-5cf7-9f12661412a9",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72514-3",
          "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
        } ],
        "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "effectiveDateTime": "2023-06-10T03:16:29+00:00",
      "issued": "2023-06-10T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 0,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3ee1-24e38ab13498",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-3ee1-24e38ab13498",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "29463-7",
          "display": "Body Weight"
        } ],
        "text": "Body Weight"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "effectiveDateTime": "2023-06-10T03:16:29+00:00",
      "issued": "2023-06-10T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 66.400,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6805-9f83c83a4b58",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-6805-9f83c83a4b58",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "Body mass index (BMI) [Ratio]"
        } ],
        "text": "Body mass index (BMI) [Ratio]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "effectiveDateTime": "2023-06-10T03:16:29+00:00",
      "issued": "2023-06-10T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 20.580,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6b92-82d7d1b01fee",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-6b92-82d7d1b01fee",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "59576-9",
          "display": "Body mass index (BMI) [Percentile] Per age and sex"
        } ],
        "text": "Body mass index (BMI) [Percentile] Per age and sex"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "effectiveDateTime": "2023-06-10T03:16:29+00:00",
      "issued": "2023-06-10T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 39.473,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-fc2c-5efcc1bd098c",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-fc2c-5efcc1bd098c",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "85354-9",
          "display": "Blood pressure panel with all children optional"
        } ],
        "text": "Blood pressure panel with all children optional"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "effectiveDateTime": "2023-06-10T03:16:29+00:00",
      "issued": "2023-06-10T03:16:29.663+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 75,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic Blood Pressure"
          } ],
          "text": "Systolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 124,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-911b-6aebd450d8f3",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-911b-6aebd450d8f3",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "Heart rate"
        } ],
        "text": "Heart rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "effectiveDateTime": "2023-06-10T03:16:29+00:00",
      "issued": "2023-06-10T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 72,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c375-dd7d0e6225ce",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-c375-dd7d0e6225ce",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "Respiratory rate"
        } ],
        "text": "Respiratory rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "effectiveDateTime": "2023-06-10T03:16:29+00:00",
      "issued": "2023-06-10T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 13,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a54f-ca4b563a1dcb",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-a54f-ca4b563a1dcb",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72166-2",
          "display": "Tobacco smoking status"
        } ],
        "text": "Tobacco smoking status"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "effectiveDateTime": "2023-06-10T03:16:29+00:00",
      "issued": "2023-06-10T03:16:29.663+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "449868002",
          "display": "Smokes tobacco daily (finding)"
        } ],
        "text": "Smokes tobacco daily (finding)"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-072a-5cc68b8b7aea",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-072a-5cc68b8b7aea",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "89204-2",
          "display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
        } ],
        "text": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "effectiveDateTime": "2023-06-10T03:52:21+00:00",
      "issued": "2023-06-10T03:52:21.663+00:00",
      "valueQuantity": {
        "value": 3,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-de63-dbde019127d0",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-de63-dbde019127d0",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "430193006",
          "display": "Medication reconciliation (procedure)"
        } ],
        "text": "Medication reconciliation (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "performedPeriod": {
        "start": "2023-06-10T03:16:29+00:00",
        "end": "2023-06-10T03:31:29+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a596-0caadf3e7376",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-a596-0caadf3e7376",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "performedPeriod": {
        "start": "2023-06-10T03:16:29+00:00",
        "end": "2023-06-10T03:28:34+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7b2a-084116a263ba",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-7b2a-084116a263ba",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "715252007",
          "display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
        } ],
        "text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "performedPeriod": {
        "start": "2023-06-10T03:28:34+00:00",
        "end": "2023-06-10T03:52:21+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6a80-922baaabc954",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-6a80-922baaabc954",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "428211000124100",
          "display": "Assessment of substance use (procedure)"
        } ],
        "text": "Assessment of substance use (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "performedPeriod": {
        "start": "2023-06-10T03:52:21+00:00",
        "end": "2023-06-10T04:06:19+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c1f3-2051011ee54c",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-c1f3-2051011ee54c",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "868187001",
          "display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
        } ],
        "text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "performedPeriod": {
        "start": "2023-06-10T04:06:19+00:00",
        "end": "2023-06-10T04:22:16+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c80e-3e74135c1b8e",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-c80e-3e74135c1b8e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "370995009",
          "display": "Health risks education (procedure)"
        } ],
        "text": "Health risks education (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "performedPeriod": {
        "start": "2023-06-10T04:22:16+00:00",
        "end": "2023-06-10T04:30:20+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d2bc-3399539f9bc5",
        "display": "Risk activity involvement (finding)"
      }, {
        "reference": "urn:uuid:a00b5c95-fed5-f472-181c-6bfcf40bd6b1",
        "display": "Risk activity involvement (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5e37-4f91dcb90397",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-5e37-4f91dcb90397",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "140",
          "display": "Influenza, split virus, trivalent, PF"
        } ],
        "text": "Influenza, split virus, trivalent, PF"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "date": "2023-06-10T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ef49-75c47f09db32",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-ef49-75c47f09db32",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "89206-7",
          "display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
        } ],
        "text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
      },
      "effectiveDateTime": "2023-06-10T03:52:21+00:00",
      "issued": "2023-06-10T03:52:21.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-072a-5cc68b8b7aea",
        "display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d5eb-620e412da544",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-d5eb-620e412da544",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2023-06-10T03:16:29+00:00",
        "end": "2023-06-10T03:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-5e37-4f91dcb90397"
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-302f-dc055aa251a2"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-181c-6bfcf40bd6b1"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-de63-dbde019127d0"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-a596-0caadf3e7376"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-7b2a-084116a263ba"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-6a80-922baaabc954"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c1f3-2051011ee54c"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c80e-3e74135c1b8e"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-d08b-70f5cee5ef6c"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 4,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "net": {
          "value": 215.70,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "procedureLinkId": [ 2 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "procedureLinkId": [ 3 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "715252007"
          } ]
        },
        "net": {
          "value": 34.51,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "procedureLinkId": [ 4 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "428211000124100"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 9,
        "procedureLinkId": [ 5 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "868187001"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 10,
        "diagnosisLinkId": [ 2 ]
      }, {
        "sequence": 11,
        "procedureLinkId": [ 6 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "370995009"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 2323.19,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:59c3cd5d-397c-3b92-951b-ca86762559a0",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "59c3cd5d-397c-3b92-951b-ca86762559a0",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-d5eb-620e412da544"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2023-06-10T03:31:29+00:00",
        "end": "2024-06-10T03:31:29+00:00"
      },
      "provider": {
        "identifier": {
          "value": "2e3b72c0-7af9-3c34-a705-d894aacce6ac"
        }
      },
      "organization": {
        "identifier": {
          "value": "6f90eaad-abe3-3ce0-b9a6-2031c5674f0d"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999943696"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-302f-dc055aa251a2"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-181c-6bfcf40bd6b1"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.360000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 109.44000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 43.14,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 172.56,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 215.70,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 215.70,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 5,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 6,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "715252007"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 6.902,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 27.608,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 34.51,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 34.51,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 7,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 8,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "428211000124100"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 9,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "868187001"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 10,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 11,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "370995009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 919.90,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 1858.5519999999997,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a3b9-87e560d2fa87",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-a3b9-87e560d2fa87",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "EMER"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "50849002",
          "display": "Emergency room admission (procedure)"
        } ],
        "text": "Emergency room admission (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999893693",
          "display": "Dr. Dudley365 Kutch271"
        }
      } ],
      "period": {
        "start": "2023-11-12T03:51:03+00:00",
        "end": "2023-11-12T04:51:03+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "125605004",
          "display": "Fracture of bone (disorder)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1ef8d603-bec1-35f5-a830-2a0b919cf47f",
        "display": "SUTTON HILL CENTER"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9c76-cc391abc944f",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-9c76-cc391abc944f",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "125605004",
          "display": "Fracture of bone (disorder)"
        } ],
        "text": "Fracture of bone (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a3b9-87e560d2fa87"
      },
      "onsetDateTime": "2023-11-12T03:51:03+00:00",
      "abatementDateTime": "2023-12-30T04:16:04+00:00",
      "assertedDate": "2023-11-12T03:51:03+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c647-ed5230a1b538",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-c647-ed5230a1b538",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "16114001",
          "display": "Fracture of ankle (disorder)"
        } ],
        "text": "Fracture of ankle (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a3b9-87e560d2fa87"
      },
      "onsetDateTime": "2023-11-12T03:51:03+00:00",
      "abatementDateTime": "2023-12-30T04:16:04+00:00",
      "assertedDate": "2023-11-12T03:51:03+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c79d-0e7c11da3980",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-c79d-0e7c11da3980",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "1290459008",
          "display": "Plain X-ray of ankle region (procedure)"
        } ],
        "text": "Plain X-ray of ankle region (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a3b9-87e560d2fa87"
      },
      "performedPeriod": {
        "start": "2023-11-12T03:51:03+00:00",
        "end": "2023-11-12T04:21:03+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c0ed-839eb330652a",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-c0ed-839eb330652a",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274474001",
          "display": "Bone immobilization (procedure)"
        } ],
        "text": "Bone immobilization (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a3b9-87e560d2fa87"
      },
      "performedPeriod": {
        "start": "2023-11-12T03:51:03+00:00",
        "end": "2023-11-12T04:16:04+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c647-ed5230a1b538",
        "display": "Fracture of ankle (disorder)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0893-fdbbb551587b",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "a00b5c95-fed5-f472-0893-fdbbb551587b",
      "status": "completed",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "849574",
          "display": "Naproxen sodium 220 MG Oral Tablet"
        } ],
        "text": "Naproxen sodium 220 MG Oral Tablet"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a3b9-87e560d2fa87"
      },
      "authoredOn": "2023-11-12T04:16:04+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999893693",
          "display": "Dr. Dudley365 Kutch271"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1ef8d603-bec1-35f5-a830-2a0b919cf47f",
          "display": "SUTTON HILL CENTER"
        }
      },
      "dosageInstruction": [ {
        "sequence": 1,
        "asNeededBoolean": true
      } ]
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-2018-3c7faf114d80",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-2018-3c7faf114d80",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2023-11-12T03:51:03+00:00",
        "end": "2023-11-12T04:51:03+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1ef8d603-bec1-35f5-a830-2a0b919cf47f",
        "display": "SUTTON HILL CENTER"
      },
      "prescription": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0893-fdbbb551587b"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-a3b9-87e560d2fa87"
        } ]
      } ],
      "total": {
        "value": 91.72,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5c15-ff64d2b48f8d",
    "resource": {
      "resourceType": "CarePlan",
      "id": "a00b5c95-fed5-f472-5c15-ff64d2b48f8d",
      "status": "completed",
      "intent": "order",
      "category": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "385691007",
          "display": "Fracture care (regime/therapy)"
        } ],
        "text": "Fracture care (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a3b9-87e560d2fa87"
      },
      "period": {
        "start": "2023-11-12T04:16:04+00:00",
        "end": "2023-12-30T04:16:04+00:00"
      },
      "addresses": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c647-ed5230a1b538"
      } ],
      "activity": [ {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "183051005",
              "display": "Recommendation to rest (procedure)"
            } ],
            "text": "Recommendation to rest (procedure)"
          },
          "status": "completed"
        }
      }, {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "408580007",
              "display": "Physical activity target light exercise (finding)"
            } ],
            "text": "Physical activity target light exercise (finding)"
          },
          "status": "completed"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "CarePlan"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4f45-4d1539571b8d",
    "resource": {
      "resourceType": "ImagingStudy",
      "id": "a00b5c95-fed5-f472-4f45-4d1539571b8d",
      "uid": "urn:oid:1.2.840.99999999.72009405.1699761063663",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-a3b9-87e560d2fa87"
      },
      "started": "2023-11-12T03:51:03+00:00",
      "numberOfSeries": 1,
      "numberOfInstances": 1,
      "procedureCode": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "1290459008",
          "display": "Plain X-ray of ankle region (procedure)"
        } ],
        "text": "Plain X-ray of ankle region (procedure)"
      } ],
      "series": [ {
        "uid": "urn:oid:1.2.840.99999999.1.49774122.1699761063663",
        "number": 1,
        "modality": {
          "system": "http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html",
          "code": "DX",
          "display": "Digital Radiography"
        },
        "numberOfInstances": 1,
        "availability": "UNAVAILABLE",
        "bodySite": {
          "system": "http://snomed.info/sct",
          "code": "344001",
          "display": "Ankle region structure (body structure)"
        },
        "started": "2023-11-12T03:51:03+00:00",
        "instance": [ {
          "uid": "urn:oid:1.2.840.99999999.1.1.99447498.1699761063663",
          "number": 1,
          "sopClass": "urn:oid:1.2.840.10008.5.1.4.1.1.1.1",
          "title": "Image of ankle"
        } ]
      } ]
    },
    "request": {
      "method": "POST",
      "url": "ImagingStudy"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5254-56b66e846cf4",
    "resource": {
      "resourceType": "Device",
      "id": "a00b5c95-fed5-f472-5254-56b66e846cf4",
      "udi": {
        "deviceIdentifier": "26856630410570",
        "carrierHRF": "(01)26856630410570(11)231022(17)481105(10)9111(21)3970163971101149905"
      },
      "status": "active",
      "type": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "228869008",
          "display": "Manual wheelchair (physical object)"
        } ],
        "text": "Manual wheelchair (physical object)"
      },
      "lotNumber": "9111",
      "manufactureDate": "2023-10-22T03:51:03+00:00",
      "expirationDate": "2048-11-05T03:51:03+00:00",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      }
    },
    "request": {
      "method": "POST",
      "url": "Device"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b554-0113b73af363",
    "resource": {
      "resourceType": "Device",
      "id": "a00b5c95-fed5-f472-b554-0113b73af363",
      "udi": {
        "deviceIdentifier": "18708868578001",
        "carrierHRF": "(01)18708868578001(11)231022(17)481105(10)130338628(21)729100"
      },
      "status": "active",
      "type": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "705417005",
          "display": "Wheelchair accessory (physical object)"
        } ],
        "text": "Wheelchair accessory (physical object)"
      },
      "lotNumber": "130338628",
      "manufactureDate": "2023-10-22T03:51:03+00:00",
      "expirationDate": "2048-11-05T03:51:03+00:00",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      }
    },
    "request": {
      "method": "POST",
      "url": "Device"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-2ae2-9f814c5e9d3e",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-2ae2-9f814c5e9d3e",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2023-11-12T03:51:03+00:00",
        "end": "2023-11-12T04:51:03+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1ef8d603-bec1-35f5-a830-2a0b919cf47f",
        "display": "SUTTON HILL CENTER"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-9c76-cc391abc944f"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c647-ed5230a1b538"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c79d-0e7c11da3980"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c0ed-839eb330652a"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 146.18,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-a3b9-87e560d2fa87"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 2 ]
      }, {
        "sequence": 4,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "1290459008"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "procedureLinkId": [ 2 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "274474001"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 1008.98,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:a873cf8c-e1c2-41dc-e5e4-83f1811a3f05",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "a873cf8c-e1c2-41dc-e5e4-83f1811a3f05",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999893693"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999893693"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-2ae2-9f814c5e9d3e"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2023-11-12T04:51:03+00:00",
        "end": "2024-11-12T04:51:03+00:00"
      },
      "created": "2023-11-12T04:51:03+00:00",
      "provider": {
        "identifier": {
          "value": "64630525-37d1-3797-9add-f1b4aecdb78a"
        }
      },
      "organization": {
        "identifier": {
          "value": "1ef8d603-bec1-35f5-a830-2a0b919cf47f"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2ae2-9f814c5e9d3e"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999893693"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-9c76-cc391abc944f"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c647-ed5230a1b538"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2023-11-12T03:51:03+00:00",
          "end": "2023-11-12T04:51:03+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "23",
            "display": "Emergency Room"
          } ]
        },
        "net": {
          "value": 146.18,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-a3b9-87e560d2fa87"
        } ],
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 29.236000000000004,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 116.94400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 146.18,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 146.18,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2023-11-12T03:51:03+00:00",
          "end": "2023-11-12T04:51:03+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "23",
            "display": "Emergency Room"
          } ]
        }
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 2 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2023-11-12T03:51:03+00:00",
          "end": "2023-11-12T04:51:03+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "23",
            "display": "Emergency Room"
          } ]
        }
      }, {
        "sequence": 4,
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "1290459008"
          } ]
        },
        "servicedPeriod": {
          "start": "2023-11-12T03:51:03+00:00",
          "end": "2023-11-12T04:51:03+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "23",
            "display": "Emergency Room"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      }, {
        "sequence": 5,
        "informationLinkId": [ 1 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2023-11-12T03:51:03+00:00",
          "end": "2023-11-12T04:51:03+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "23",
            "display": "Emergency Room"
          } ]
        },
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      }, {
        "sequence": 6,
        "informationLinkId": [ 2 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2023-11-12T03:51:03+00:00",
          "end": "2023-11-12T04:51:03+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "23",
            "display": "Emergency Room"
          } ]
        },
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      }, {
        "sequence": 7,
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "274474001"
          } ]
        },
        "servicedPeriod": {
          "start": "2023-11-12T03:51:03+00:00",
          "end": "2023-11-12T04:51:03+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "23",
            "display": "Emergency Room"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 1008.98,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 807.184,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5559-e0e19e5c59a5",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-5559-e0e19e5c59a5",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "185349003",
          "display": "Encounter for check up (procedure)"
        } ],
        "text": "Encounter for check up (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2023-12-30T04:16:04+00:00",
        "end": "2023-12-30T04:31:04+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "16114001",
          "display": "Fracture of ankle (disorder)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-69fe-6cf8ee499575",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-69fe-6cf8ee499575",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2023-12-30T04:16:04+00:00",
        "end": "2023-12-30T04:31:04+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-5559-e0e19e5c59a5"
        } ]
      } ],
      "total": {
        "value": 85.55,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:8641dd60-1a2d-f913-21de-235f647d64b5",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "8641dd60-1a2d-f913-21de-235f647d64b5",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-69fe-6cf8ee499575"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2023-12-30T04:31:04+00:00",
        "end": "2024-12-30T04:31:04+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 17.11,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 68.44,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 85.55,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 68.44,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-f00c-bc4e896182d2",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-f00c-bc4e896182d2",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "185345009",
          "display": "Encounter for symptom (procedure)"
        } ],
        "text": "Encounter for symptom (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2024-04-09T05:16:29+00:00",
        "end": "2024-04-09T05:35:01+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "10509002",
          "display": "Acute bronchitis (disorder)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-778d-4832690e64ec",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-778d-4832690e64ec",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "10509002",
          "display": "Acute bronchitis (disorder)"
        } ],
        "text": "Acute bronchitis (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f00c-bc4e896182d2"
      },
      "onsetDateTime": "2024-04-09T05:16:29+00:00",
      "abatementDateTime": "2024-04-19T05:35:01+00:00",
      "assertedDate": "2024-04-09T05:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4b3a-82a569667ac5",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-4b3a-82a569667ac5",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "23426006",
          "display": "Measurement of respiratory function (procedure)"
        } ],
        "text": "Measurement of respiratory function (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f00c-bc4e896182d2"
      },
      "performedPeriod": {
        "start": "2024-04-09T05:16:29+00:00",
        "end": "2024-04-09T05:35:01+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-778d-4832690e64ec",
        "display": "Acute bronchitis (disorder)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b918-11205872b5af",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "a00b5c95-fed5-f472-b918-11205872b5af",
      "status": "completed",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "313782",
          "display": "Acetaminophen 325 MG Oral Tablet"
        } ],
        "text": "Acetaminophen 325 MG Oral Tablet"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f00c-bc4e896182d2"
      },
      "authoredOn": "2024-04-09T05:35:01+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
          "display": "LAWRENCE GENERAL HOSPITAL"
        }
      },
      "reasonReference": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-778d-4832690e64ec"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-39a6-29a9ab983648",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-39a6-29a9ab983648",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2024-04-09T05:16:29+00:00",
        "end": "2024-04-09T05:35:01+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "prescription": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-b918-11205872b5af"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-f00c-bc4e896182d2"
        } ]
      } ],
      "total": {
        "value": 154.43,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ab44-cfb5db63913b",
    "resource": {
      "resourceType": "CarePlan",
      "id": "a00b5c95-fed5-f472-ab44-cfb5db63913b",
      "status": "completed",
      "intent": "order",
      "category": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "53950000",
          "display": "Respiratory therapy (procedure)"
        } ],
        "text": "Respiratory therapy (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f00c-bc4e896182d2"
      },
      "period": {
        "start": "2024-04-09T05:35:01+00:00",
        "end": "2024-06-15T03:16:29+00:00"
      },
      "activity": [ {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "304510005",
              "display": "Recommendation to avoid exercise (procedure)"
            } ],
            "text": "Recommendation to avoid exercise (procedure)"
          },
          "status": "completed"
        }
      }, {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "371605008",
              "display": "Deep breathing and coughing exercises (regime/therapy)"
            } ],
            "text": "Deep breathing and coughing exercises (regime/therapy)"
          },
          "status": "completed"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "CarePlan"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-64d2-f114d122ccb8",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-64d2-f114d122ccb8",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2024-04-09T05:16:29+00:00",
        "end": "2024-04-09T05:35:01+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-778d-4832690e64ec"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-4b3a-82a569667ac5"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-f00c-bc4e896182d2"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 3,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "23426006"
          } ]
        },
        "net": {
          "value": 222.99,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 308.54,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:bcc9d3c4-4738-8f27-7a75-d258e650dd92",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "bcc9d3c4-4738-8f27-7a75-d258e650dd92",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-64d2-f114d122ccb8"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2024-04-09T05:35:01+00:00",
        "end": "2025-04-09T05:35:01+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-778d-4832690e64ec"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 17.11,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 68.44,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "23426006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 44.598000000000006,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 178.39200000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 222.99,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 222.99,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 308.54,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 246.83200000000002,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-9774-ca24ac83649d",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "162673000",
          "display": "General examination of patient (procedure)"
        } ],
        "text": "General examination of patient (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999943696",
          "display": "Dr. Claribel706 Wuckert783"
        }
      } ],
      "period": {
        "start": "2024-06-15T03:16:29+00:00",
        "end": "2024-06-15T03:58:17+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c547-531296402161",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-c547-531296402161",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "314529007",
          "display": "Medication review due (situation)"
        } ],
        "text": "Medication review due (situation)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "onsetDateTime": "2024-06-15T03:16:29+00:00",
      "abatementDateTime": "2024-06-15T03:16:29+00:00",
      "assertedDate": "2024-06-15T03:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6e1d-cf41e6dc76b6",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-6e1d-cf41e6dc76b6",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "224299000",
          "display": "Received higher education (finding)"
        } ],
        "text": "Received higher education (finding)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "onsetDateTime": "2024-06-15T03:58:17+00:00",
      "assertedDate": "2024-06-15T03:58:17+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4f9e-5ee46957f574",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-4f9e-5ee46957f574",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "160903007",
          "display": "Full-time employment (finding)"
        } ],
        "text": "Full-time employment (finding)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "onsetDateTime": "2024-06-15T03:58:17+00:00",
      "assertedDate": "2024-06-15T03:58:17+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-015e-1d0538cf35bf",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-015e-1d0538cf35bf",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "423315002",
          "display": "Limited social contact (finding)"
        } ],
        "text": "Limited social contact (finding)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "onsetDateTime": "2024-06-15T03:58:17+00:00",
      "abatementDateTime": "2025-06-21T04:08:31+00:00",
      "assertedDate": "2024-06-15T03:58:17+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-dfb9-9553e29832e4",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-dfb9-9553e29832e4",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "73595000",
          "display": "Stress (finding)"
        } ],
        "text": "Stress (finding)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "onsetDateTime": "2024-06-15T03:58:17+00:00",
      "assertedDate": "2024-06-15T03:58:17+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ef50-b151cea3329b",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-ef50-b151cea3329b",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "Body Height"
        } ],
        "text": "Body Height"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T03:16:29+00:00",
      "issued": "2024-06-15T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 180.40,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5b3a-f44aba7d0188",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-5b3a-f44aba7d0188",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72514-3",
          "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
        } ],
        "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T03:16:29+00:00",
      "issued": "2024-06-15T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 1,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6543-1e92d5cb3c13",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-6543-1e92d5cb3c13",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "29463-7",
          "display": "Body Weight"
        } ],
        "text": "Body Weight"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T03:16:29+00:00",
      "issued": "2024-06-15T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 68.400,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e8a4-15748abce73b",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-e8a4-15748abce73b",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "Body mass index (BMI) [Ratio]"
        } ],
        "text": "Body mass index (BMI) [Ratio]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T03:16:29+00:00",
      "issued": "2024-06-15T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 21.020,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c100-1ecdb7dbae86",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-c100-1ecdb7dbae86",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "59576-9",
          "display": "Body mass index (BMI) [Percentile] Per age and sex"
        } ],
        "text": "Body mass index (BMI) [Percentile] Per age and sex"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T03:16:29+00:00",
      "issued": "2024-06-15T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 36.744,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-93b8-ea92f937aba1",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-93b8-ea92f937aba1",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "85354-9",
          "display": "Blood pressure panel with all children optional"
        } ],
        "text": "Blood pressure panel with all children optional"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T03:16:29+00:00",
      "issued": "2024-06-15T03:16:29.663+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 74,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic Blood Pressure"
          } ],
          "text": "Systolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 123,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-fe85-c843ae12aeee",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-fe85-c843ae12aeee",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "Heart rate"
        } ],
        "text": "Heart rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T03:16:29+00:00",
      "issued": "2024-06-15T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 86,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d51c-2bf7936b0a54",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-d51c-2bf7936b0a54",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "Respiratory rate"
        } ],
        "text": "Respiratory rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T03:16:29+00:00",
      "issued": "2024-06-15T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 13,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-dbff-b32c5c8e7abc",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-dbff-b32c5c8e7abc",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72166-2",
          "display": "Tobacco smoking status"
        } ],
        "text": "Tobacco smoking status"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T03:16:29+00:00",
      "issued": "2024-06-15T03:16:29.663+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "8517006",
          "display": "Ex-smoker (finding)"
        } ],
        "text": "Ex-smoker (finding)"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0416-25f1323e0715",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-0416-25f1323e0715",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "93025-5",
          "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
        } ],
        "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T03:58:17+00:00",
      "issued": "2024-06-15T03:58:17.663+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "76501-6",
            "display": "Within the last year, have you been afraid of your partner or ex-partner"
          } ],
          "text": "Within the last year, have you been afraid of your partner or ex-partner"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93026-3",
            "display": "Do you feel physically and emotionally safe where you currently live [PRAPARE]"
          } ],
          "text": "Do you feel physically and emotionally safe where you currently live [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA33-6",
            "display": "Yes"
          } ],
          "text": "Yes"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93027-1",
            "display": "Are you a refugee"
          } ],
          "text": "Are you a refugee"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93028-9",
            "display": "Have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility in past 1 year [PRAPARE]"
          } ],
          "text": "Have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility in past 1 year [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93038-8",
            "display": "Stress level"
          } ],
          "text": "Stress level"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA13909-9",
            "display": "Somewhat"
          } ],
          "text": "Somewhat"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93029-7",
            "display": "How often do you see or talk to people that you care about and feel close to [PRAPARE]"
          } ],
          "text": "How often do you see or talk to people that you care about and feel close to [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30130-1",
            "display": "1 or 2 times a week"
          } ],
          "text": "1 or 2 times a week"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93030-5",
            "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
          } ],
          "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93031-3",
            "display": "Have you or any family members you live with been unable to get any of the following when it was really needed in past 1 year [PRAPARE]"
          } ],
          "text": "Have you or any family members you live with been unable to get any of the following when it was really needed in past 1 year [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30122-8",
            "display": "I choose not to answer this question"
          } ],
          "text": "I choose not to answer this question"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "63586-2",
            "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]"
          } ],
          "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]"
        },
        "valueQuantity": {
          "value": 73834,
          "unit": "/a",
          "system": "http://unitsofmeasure.org",
          "code": "/a"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "76437-3",
            "display": "Primary insurance"
          } ],
          "text": "Primary insurance"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA6350-8",
            "display": "Private insurance"
          } ],
          "text": "Private insurance"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "67875-5",
            "display": "Employment status - current"
          } ],
          "text": "Employment status - current"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30136-8",
            "display": "Full-time work"
          } ],
          "text": "Full-time work"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "82589-3",
            "display": "Highest level of education"
          } ],
          "text": "Highest level of education"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30193-9",
            "display": "More than high school"
          } ],
          "text": "More than high school"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "56799-0",
            "display": "Address"
          } ],
          "text": "Address"
        },
        "valueString": "590 Mayert Quay Unit 26"
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93033-9",
            "display": "Are you worried about losing your housing [PRAPARE]"
          } ],
          "text": "Are you worried about losing your housing [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "71802-3",
            "display": "Housing status"
          } ],
          "text": "Housing status"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30189-7",
            "display": "I have housing"
          } ],
          "text": "I have housing"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "63512-8",
            "display": "How many people are living or staying at this address [#]"
          } ],
          "text": "How many people are living or staying at this address [#]"
        },
        "valueQuantity": {
          "value": 8,
          "unit": "{#}",
          "system": "http://unitsofmeasure.org",
          "code": "{#}"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "54899-0",
            "display": "Preferred language"
          } ],
          "text": "Preferred language"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA43-5",
            "display": "English"
          } ],
          "text": "English"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93034-7",
            "display": "Discharged from the U.S. Armed Forces"
          } ],
          "text": "Discharged from the U.S. Armed Forces"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93035-4",
            "display": "Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]"
          } ],
          "text": "Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "32624-9",
            "display": "Race"
          } ],
          "text": "Race"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA4457-3",
            "display": "White"
          } ],
          "text": "White"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "56051-6",
            "display": "Hispanic or Latino"
          } ],
          "text": "Hispanic or Latino"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3ab6-3fde1a568ff2",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-3ab6-3fde1a568ff2",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "76504-0",
          "display": "Total score [HARK]"
        } ],
        "text": "Total score [HARK]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T04:37:04+00:00",
      "issued": "2024-06-15T04:37:04.663+00:00",
      "valueQuantity": {
        "value": 0,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b360-906aa418dde2",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-b360-906aa418dde2",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55758-7",
          "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
        } ],
        "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T05:16:40+00:00",
      "issued": "2024-06-15T05:16:40.663+00:00",
      "valueQuantity": {
        "value": 2,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8115-748340cafd1a",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-8115-748340cafd1a",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "430193006",
          "display": "Medication reconciliation (procedure)"
        } ],
        "text": "Medication reconciliation (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "performedPeriod": {
        "start": "2024-06-15T03:16:29+00:00",
        "end": "2024-06-15T03:31:29+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-728a-a143345b4a1e",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-728a-a143345b4a1e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "710824005",
          "display": "Assessment of health and social care needs (procedure)"
        } ],
        "text": "Assessment of health and social care needs (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "performedPeriod": {
        "start": "2024-06-15T03:16:29+00:00",
        "end": "2024-06-15T03:58:17+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0abb-72792dd5a5db",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-0abb-72792dd5a5db",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "866148006",
          "display": "Screening for domestic abuse (procedure)"
        } ],
        "text": "Screening for domestic abuse (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "performedPeriod": {
        "start": "2024-06-15T03:58:17+00:00",
        "end": "2024-06-15T04:37:04+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6b3d-f0e4b4052fc4",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-6b3d-f0e4b4052fc4",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "performedPeriod": {
        "start": "2024-06-15T04:37:04+00:00",
        "end": "2024-06-15T04:50:41+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-01a1-9d230c005513",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-01a1-9d230c005513",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "performedPeriod": {
        "start": "2024-06-15T04:50:41+00:00",
        "end": "2024-06-15T05:16:40+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5bc5-7b02e60c81e1",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-5bc5-7b02e60c81e1",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "103697008",
          "display": "Patient referral for dental care (procedure)"
        } ],
        "text": "Patient referral for dental care (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "performedPeriod": {
        "start": "2024-06-15T05:16:40+00:00",
        "end": "2024-06-15T05:31:15+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b34d-82e70b472786",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-b34d-82e70b472786",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "140",
          "display": "Influenza, split virus, trivalent, PF"
        } ],
        "text": "Influenza, split virus, trivalent, PF"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "date": "2024-06-15T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c39e-1a6c4682f7b1",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-c39e-1a6c4682f7b1",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "76499-3",
          "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
        } ],
        "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T04:37:04+00:00",
      "issued": "2024-06-15T04:37:04.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-3ab6-3fde1a568ff2",
        "display": "Total score [HARK]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d6f4-093a7f873d57",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-d6f4-093a7f873d57",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55757-9",
          "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
        } ],
        "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
      },
      "effectiveDateTime": "2024-06-15T05:16:40+00:00",
      "issued": "2024-06-15T05:16:40.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-b360-906aa418dde2",
        "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c155-ab9b7b1446e4",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-c155-ab9b7b1446e4",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2024-06-15T03:16:29+00:00",
        "end": "2024-06-15T03:58:17+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-b34d-82e70b472786"
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 3,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c547-531296402161"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-6e1d-cf41e6dc76b6"
        }
      }, {
        "sequence": 3,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-4f9e-5ee46957f574"
        }
      }, {
        "sequence": 4,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-015e-1d0538cf35bf"
        }
      }, {
        "sequence": 5,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-dfb9-9553e29832e4"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-8115-748340cafd1a"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-728a-a143345b4a1e"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0abb-72792dd5a5db"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-6b3d-f0e4b4052fc4"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-01a1-9d230c005513"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-5bc5-7b02e60c81e1"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-9774-ca24ac83649d"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 4,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "net": {
          "value": 215.70,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "procedureLinkId": [ 2 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710824005"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "diagnosisLinkId": [ 2 ]
      }, {
        "sequence": 7,
        "diagnosisLinkId": [ 3 ]
      }, {
        "sequence": 8,
        "diagnosisLinkId": [ 4 ]
      }, {
        "sequence": 9,
        "diagnosisLinkId": [ 5 ]
      }, {
        "sequence": 10,
        "procedureLinkId": [ 3 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "866148006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 11,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 12,
        "procedureLinkId": [ 4 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 13,
        "procedureLinkId": [ 5 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 14,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 15,
        "procedureLinkId": [ 6 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "103697008"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 2794.66,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:f87d2f7d-1e09-e399-9da5-00559a714e99",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "f87d2f7d-1e09-e399-9da5-00559a714e99",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-c155-ab9b7b1446e4"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2024-06-15T03:58:17+00:00",
        "end": "2025-06-15T03:58:17+00:00"
      },
      "provider": {
        "identifier": {
          "value": "2e3b72c0-7af9-3c34-a705-d894aacce6ac"
        }
      },
      "organization": {
        "identifier": {
          "value": "6f90eaad-abe3-3ce0-b9a6-2031c5674f0d"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999943696"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c547-531296402161"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-6e1d-cf41e6dc76b6"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 3,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-4f9e-5ee46957f574"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 4,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-015e-1d0538cf35bf"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 5,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-dfb9-9553e29832e4"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.360000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 109.44000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "430193006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 43.14,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 172.56,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 215.70,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 215.70,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 5,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710824005"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 6,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 7,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 8,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 9,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 10,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "866148006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 11,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 12,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 13,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 14,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 15,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "103697008"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 919.90,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 2235.728,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-f8d6-1659fd181270",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "185349003",
          "display": "Encounter for check up (procedure)"
        } ],
        "text": "Encounter for check up (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2024-06-29T03:16:29+00:00",
        "end": "2024-06-29T06:56:35+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "103697008",
          "display": "Patient referral for dental care (procedure)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-bed9-438cd28eddda",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-bed9-438cd28eddda",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "34043003",
          "display": "Dental consultation and report (procedure)"
        } ],
        "text": "Dental consultation and report (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270"
      },
      "performedPeriod": {
        "start": "2024-06-29T03:16:29+00:00",
        "end": "2024-06-29T03:43:25+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-f16f-549c4aa4360f",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-f16f-549c4aa4360f",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225362009",
          "display": "Dental care (regime/therapy)"
        } ],
        "text": "Dental care (regime/therapy)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270"
      },
      "performedPeriod": {
        "start": "2024-06-29T03:43:25+00:00",
        "end": "2024-06-29T04:17:35+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-1038-ad9899cba62b",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-1038-ad9899cba62b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "1260009003",
          "display": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)"
        } ],
        "text": "Removal of supragingival plaque and calculus from all teeth using dental instrument (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270"
      },
      "performedPeriod": {
        "start": "2024-06-29T04:17:35+00:00",
        "end": "2024-06-29T04:56:52+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-99c8-b5262f066a29",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-99c8-b5262f066a29",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "1260010008",
          "display": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)"
        } ],
        "text": "Removal of subgingival plaque and calculus from all teeth using dental instrument (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270"
      },
      "performedPeriod": {
        "start": "2024-06-29T04:56:52+00:00",
        "end": "2024-06-29T05:17:29+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-1643-54d1897ef908",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-1643-54d1897ef908",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274788003",
          "display": "Examination of gingivae (procedure)"
        } ],
        "text": "Examination of gingivae (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270"
      },
      "performedPeriod": {
        "start": "2024-06-29T05:17:29+00:00",
        "end": "2024-06-29T06:11:50+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3475-b6827d2c621c",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-3475-b6827d2c621c",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "68071007",
          "display": "Dental fluoride treatment (procedure)"
        } ],
        "text": "Dental fluoride treatment (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270"
      },
      "performedPeriod": {
        "start": "2024-06-29T06:11:50+00:00",
        "end": "2024-06-29T06:46:04+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-2ac4-38ffb2e1e4cf",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-2ac4-38ffb2e1e4cf",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "243085009",
          "display": "Oral health education (procedure)"
        } ],
        "text": "Oral health education (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270"
      },
      "performedPeriod": {
        "start": "2024-06-29T06:46:04+00:00",
        "end": "2024-06-29T06:56:35+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-28d9-69116dfea45e",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "a00b5c95-fed5-f472-28d9-69116dfea45e",
      "status": "completed",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "1535362",
          "display": "sodium fluoride 0.0272 MG/MG Oral Gel"
        } ],
        "text": "sodium fluoride 0.0272 MG/MG Oral Gel"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270"
      },
      "authoredOn": "2024-06-29T06:11:50+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
          "display": "LAWRENCE GENERAL HOSPITAL"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7069-419d247edd11",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-7069-419d247edd11",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2024-06-29T03:16:29+00:00",
        "end": "2024-06-29T06:56:35+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "prescription": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-28d9-69116dfea45e"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270"
        } ]
      } ],
      "total": {
        "value": 129.94,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:44d4f778-7175-3dc0-41fe-361163bce318",
    "resource": {
      "resourceType": "MedicationAdministration",
      "id": "44d4f778-7175-3dc0-41fe-361163bce318",
      "status": "completed",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "1535362",
          "display": "sodium fluoride 0.0272 MG/MG Oral Gel"
        } ],
        "text": "sodium fluoride 0.0272 MG/MG Oral Gel"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270"
      },
      "effectiveDateTime": "2024-06-29T06:11:50+00:00"
    },
    "request": {
      "method": "POST",
      "url": "MedicationAdministration"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8aa1-4252ab0d4d66",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "a00b5c95-fed5-f472-8aa1-4252ab0d4d66",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 1
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "277183007",
            "display": "Dental equipment (physical object)"
          } ],
          "text": "Dental equipment (physical object)"
        }
      },
      "occurrenceDateTime": "2024-06-29T04:17:35+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-37b9-157346e91094",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "a00b5c95-fed5-f472-37b9-157346e91094",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 1
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "1230220004",
            "display": "Conventional release periodontal gel (dose form)"
          } ],
          "text": "Conventional release periodontal gel (dose form)"
        }
      },
      "occurrenceDateTime": "2024-06-29T04:17:35+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b080-15510640779a",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "a00b5c95-fed5-f472-b080-15510640779a",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 1
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "469020004",
            "display": "Dental floss (physical object)"
          } ],
          "text": "Dental floss (physical object)"
        }
      },
      "occurrenceDateTime": "2024-06-29T04:17:35+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-78c3-50e22cfadf29",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-78c3-50e22cfadf29",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2024-06-29T03:16:29+00:00",
        "end": "2024-06-29T06:56:35+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 3,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-bed9-438cd28eddda"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-f16f-549c4aa4360f"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-1038-ad9899cba62b"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-99c8-b5262f066a29"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-1643-54d1897ef908"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-3475-b6827d2c621c"
        }
      }, {
        "sequence": 7,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-2ac4-38ffb2e1e4cf"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-f8d6-1659fd181270"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "34043003"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "procedureLinkId": [ 2 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "225362009"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "procedureLinkId": [ 3 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "1260009003"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "procedureLinkId": [ 4 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "1260010008"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 9,
        "procedureLinkId": [ 5 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "274788003"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 10,
        "procedureLinkId": [ 6 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "68071007"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 11,
        "procedureLinkId": [ 7 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "243085009"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 3105.35,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:5f2394f0-dd96-6236-0556-1e3fa395ac86",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "5f2394f0-dd96-6236-0556-1e3fa395ac86",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-78c3-50e22cfadf29"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2024-06-29T06:56:35+00:00",
        "end": "2025-06-29T06:56:35+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 17.11,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 68.44,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "34043003"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "225362009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 5,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 6,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 0.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 0.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 7,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "1260009003"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 8,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "1260010008"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 9,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "274788003"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 10,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "68071007"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 11,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "243085009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 3105.35,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 2484.2799999999997,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4632-ecf7e45738ec",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-4632-ecf7e45738ec",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "VR"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "185347001",
          "display": "Encounter for problem (procedure)"
        } ],
        "text": "Encounter for problem (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2025-05-28T03:16:29+00:00",
        "end": "2025-05-28T03:31:29+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "40275004",
          "display": "Contact dermatitis (disorder)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0b01-c1160dd1db39",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-0b01-c1160dd1db39",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "40275004",
          "display": "Contact dermatitis (disorder)"
        } ],
        "text": "Contact dermatitis (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4632-ecf7e45738ec"
      },
      "onsetDateTime": "2025-05-28T03:16:29+00:00",
      "abatementDateTime": "2026-05-28T12:16:29+00:00",
      "assertedDate": "2025-05-28T03:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e954-45c3adb1f0bd",
    "resource": {
      "resourceType": "CarePlan",
      "id": "a00b5c95-fed5-f472-e954-45c3adb1f0bd",
      "status": "completed",
      "intent": "order",
      "category": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "711282006",
          "display": "Skin condition care (regime/therapy)"
        } ],
        "text": "Skin condition care (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4632-ecf7e45738ec"
      },
      "period": {
        "start": "2025-05-28T03:16:29+00:00",
        "end": "2026-05-28T12:16:29+00:00"
      },
      "addresses": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0b01-c1160dd1db39"
      } ],
      "activity": [ {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "225130001",
              "display": "Application of moisturizer to skin (procedure)"
            } ],
            "text": "Application of moisturizer to skin (procedure)"
          },
          "status": "completed"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "CarePlan"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-82f4-4316e88cbb73",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-82f4-4316e88cbb73",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-05-28T03:16:29+00:00",
        "end": "2025-05-28T03:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0b01-c1160dd1db39"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 75.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-4632-ecf7e45738ec"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      } ],
      "total": {
        "value": 75.00,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:b5dfa5c1-1737-3074-396f-e119146070ba",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "b5dfa5c1-1737-3074-396f-e119146070ba",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999995191"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-82f4-4316e88cbb73"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-05-28T03:31:29+00:00",
        "end": "2026-05-28T03:31:29+00:00"
      },
      "created": "2025-05-28T03:31:29+00:00",
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-82f4-4316e88cbb73"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0b01-c1160dd1db39"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2025-05-28T03:16:29+00:00",
          "end": "2025-05-28T03:31:29+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 75.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-4632-ecf7e45738ec"
        } ],
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 15.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 60.0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 75.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 75.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2025-05-28T03:16:29+00:00",
          "end": "2025-05-28T03:31:29+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        }
      } ],
      "totalCost": {
        "value": 75.00,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 60.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-15ff-48684f39f1aa",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-15ff-48684f39f1aa",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "185347001",
          "display": "Encounter for problem (procedure)"
        } ],
        "text": "Encounter for problem (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2025-05-31T12:16:29+00:00",
        "end": "2025-05-31T12:31:29+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "40275004",
          "display": "Contact dermatitis (disorder)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e632-8b50f2aaa531",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-e632-8b50f2aaa531",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "exam",
          "display": "exam"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "66519-0",
          "display": "Percentage area affected by eczema Head and Neck [PhenX]"
        } ],
        "text": "Percentage area affected by eczema Head and Neck [PhenX]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-15ff-48684f39f1aa"
      },
      "effectiveDateTime": "2025-05-31T12:16:29+00:00",
      "issued": "2025-05-31T12:16:29.663+00:00",
      "valueQuantity": {
        "value": 0,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-34e0-4ce50416b1fa",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-34e0-4ce50416b1fa",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "exam",
          "display": "exam"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "66529-9",
          "display": "Percentage area affected by eczema Trunk [PhenX]"
        } ],
        "text": "Percentage area affected by eczema Trunk [PhenX]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-15ff-48684f39f1aa"
      },
      "effectiveDateTime": "2025-05-31T12:16:29+00:00",
      "issued": "2025-05-31T12:16:29.663+00:00",
      "valueQuantity": {
        "value": 0,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-78d7-88ab8a9810f9",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-78d7-88ab8a9810f9",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "exam",
          "display": "exam"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "66524-0",
          "display": "Percentage area affected by eczema Upper extremity - bilateral [PhenX]"
        } ],
        "text": "Percentage area affected by eczema Upper extremity - bilateral [PhenX]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-15ff-48684f39f1aa"
      },
      "effectiveDateTime": "2025-05-31T12:16:29+00:00",
      "issued": "2025-05-31T12:16:29.663+00:00",
      "valueQuantity": {
        "value": 54.789,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-fd00-9a44bf617f56",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-fd00-9a44bf617f56",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "exam",
          "display": "exam"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "66534-9",
          "display": "Percentage area affected by eczema Lower extremity - bilateral [PhenX]"
        } ],
        "text": "Percentage area affected by eczema Lower extremity - bilateral [PhenX]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-15ff-48684f39f1aa"
      },
      "effectiveDateTime": "2025-05-31T12:16:29+00:00",
      "issued": "2025-05-31T12:16:29.663+00:00",
      "valueQuantity": {
        "value": 13.142,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-dd1d-06353a7cabf2",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "a00b5c95-fed5-f472-dd1d-06353a7cabf2",
      "status": "active",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "106258",
          "display": "Hydrocortisone 10 MG/ML Topical Cream"
        } ],
        "text": "Hydrocortisone 10 MG/ML Topical Cream"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-15ff-48684f39f1aa"
      },
      "authoredOn": "2025-05-31T12:16:29+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
          "display": "LAWRENCE GENERAL HOSPITAL"
        }
      },
      "reasonReference": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0b01-c1160dd1db39"
      } ],
      "dosageInstruction": [ {
        "sequence": 1,
        "asNeededBoolean": true
      } ]
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ab3e-fa6eb828ef24",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-ab3e-fa6eb828ef24",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-05-31T12:16:29+00:00",
        "end": "2025-05-31T12:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "prescription": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-dd1d-06353a7cabf2"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-15ff-48684f39f1aa"
        } ]
      } ],
      "total": {
        "value": 140.40,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-2234-380f0ae4c21d",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-2234-380f0ae4c21d",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-05-31T12:16:29+00:00",
        "end": "2025-05-31T12:31:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-15ff-48684f39f1aa"
        } ]
      } ],
      "total": {
        "value": 85.55,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:3c4b602e-c0d3-ed32-869b-72a5bc4ab331",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "3c4b602e-c0d3-ed32-869b-72a5bc4ab331",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-2234-380f0ae4c21d"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2025-05-31T12:31:29+00:00",
        "end": "2026-05-31T12:31:29+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 17.11,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 68.44,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 85.55,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 68.44,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-4f6c-eca24c566518",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "162673000",
          "display": "General examination of patient (procedure)"
        } ],
        "text": "General examination of patient (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999943696",
          "display": "Dr. Claribel706 Wuckert783"
        }
      } ],
      "period": {
        "start": "2025-06-21T03:16:29+00:00",
        "end": "2025-06-21T04:08:31+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-1c43-5007131d3a94",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-1c43-5007131d3a94",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "314529007",
          "display": "Medication review due (situation)"
        } ],
        "text": "Medication review due (situation)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "onsetDateTime": "2025-06-21T03:16:29+00:00",
      "assertedDate": "2025-06-21T03:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7e4d-823c50dce279",
    "resource": {
      "resourceType": "Condition",
      "id": "a00b5c95-fed5-f472-7e4d-823c50dce279",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "706893006",
          "display": "Victim of intimate partner abuse (finding)"
        } ],
        "text": "Victim of intimate partner abuse (finding)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "onsetDateTime": "2025-06-21T04:08:31+00:00",
      "assertedDate": "2025-06-21T04:08:31+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a24c-6452fc39e8a9",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-a24c-6452fc39e8a9",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "Body Height"
        } ],
        "text": "Body Height"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T03:16:29+00:00",
      "issued": "2025-06-21T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 180.80,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-1350-f65320a082f7",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-1350-f65320a082f7",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72514-3",
          "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
        } ],
        "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T03:16:29+00:00",
      "issued": "2025-06-21T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 1,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4de2-1900fdd9555f",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-4de2-1900fdd9555f",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "29463-7",
          "display": "Body Weight"
        } ],
        "text": "Body Weight"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T03:16:29+00:00",
      "issued": "2025-06-21T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 72.700,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0afe-f2384410e961",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-0afe-f2384410e961",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "Body mass index (BMI) [Ratio]"
        } ],
        "text": "Body mass index (BMI) [Ratio]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T03:16:29+00:00",
      "issued": "2025-06-21T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 22.240,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b4f4-ff573277a9e2",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-b4f4-ff573277a9e2",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "59576-9",
          "display": "Body mass index (BMI) [Percentile] Per age and sex"
        } ],
        "text": "Body mass index (BMI) [Percentile] Per age and sex"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T03:16:29+00:00",
      "issued": "2025-06-21T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 45.778,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-951e-3dc80a50e7a0",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-951e-3dc80a50e7a0",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "85354-9",
          "display": "Blood pressure panel with all children optional"
        } ],
        "text": "Blood pressure panel with all children optional"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T03:16:29+00:00",
      "issued": "2025-06-21T03:16:29.663+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 85,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic Blood Pressure"
          } ],
          "text": "Systolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 122,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-67e1-0117ce2dae76",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-67e1-0117ce2dae76",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "Heart rate"
        } ],
        "text": "Heart rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T03:16:29+00:00",
      "issued": "2025-06-21T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 72,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0aaf-d30bb28cfe8a",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-0aaf-d30bb28cfe8a",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "vital-signs",
          "display": "vital-signs"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "Respiratory rate"
        } ],
        "text": "Respiratory rate"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T03:16:29+00:00",
      "issued": "2025-06-21T03:16:29.663+00:00",
      "valueQuantity": {
        "value": 13,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-cde2-f3ccb50b1162",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-cde2-f3ccb50b1162",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72166-2",
          "display": "Tobacco smoking status"
        } ],
        "text": "Tobacco smoking status"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T03:16:29+00:00",
      "issued": "2025-06-21T03:16:29.663+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "8517006",
          "display": "Ex-smoker (finding)"
        } ],
        "text": "Ex-smoker (finding)"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0ec7-557705ea776e",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-0ec7-557705ea776e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "93025-5",
          "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
        } ],
        "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T04:08:31+00:00",
      "issued": "2025-06-21T04:08:31.663+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "76501-6",
            "display": "Within the last year, have you been afraid of your partner or ex-partner"
          } ],
          "text": "Within the last year, have you been afraid of your partner or ex-partner"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA33-6",
            "display": "Yes"
          } ],
          "text": "Yes"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93026-3",
            "display": "Do you feel physically and emotionally safe where you currently live [PRAPARE]"
          } ],
          "text": "Do you feel physically and emotionally safe where you currently live [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA33-6",
            "display": "Yes"
          } ],
          "text": "Yes"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93027-1",
            "display": "Are you a refugee"
          } ],
          "text": "Are you a refugee"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93028-9",
            "display": "Have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility in past 1 year [PRAPARE]"
          } ],
          "text": "Have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility in past 1 year [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93038-8",
            "display": "Stress level"
          } ],
          "text": "Stress level"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA13863-8",
            "display": "A little bit"
          } ],
          "text": "A little bit"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93029-7",
            "display": "How often do you see or talk to people that you care about and feel close to [PRAPARE]"
          } ],
          "text": "How often do you see or talk to people that you care about and feel close to [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30132-7",
            "display": "5 or more times a week"
          } ],
          "text": "5 or more times a week"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93030-5",
            "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
          } ],
          "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93031-3",
            "display": "Have you or any family members you live with been unable to get any of the following when it was really needed in past 1 year [PRAPARE]"
          } ],
          "text": "Have you or any family members you live with been unable to get any of the following when it was really needed in past 1 year [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30122-8",
            "display": "I choose not to answer this question"
          } ],
          "text": "I choose not to answer this question"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "63586-2",
            "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]"
          } ],
          "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]"
        },
        "valueQuantity": {
          "value": 73834,
          "unit": "/a",
          "system": "http://unitsofmeasure.org",
          "code": "/a"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "76437-3",
            "display": "Primary insurance"
          } ],
          "text": "Primary insurance"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA6350-8",
            "display": "Private insurance"
          } ],
          "text": "Private insurance"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "67875-5",
            "display": "Employment status - current"
          } ],
          "text": "Employment status - current"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30136-8",
            "display": "Full-time work"
          } ],
          "text": "Full-time work"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "82589-3",
            "display": "Highest level of education"
          } ],
          "text": "Highest level of education"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30193-9",
            "display": "More than high school"
          } ],
          "text": "More than high school"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "56799-0",
            "display": "Address"
          } ],
          "text": "Address"
        },
        "valueString": "590 Mayert Quay Unit 26"
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93033-9",
            "display": "Are you worried about losing your housing [PRAPARE]"
          } ],
          "text": "Are you worried about losing your housing [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "71802-3",
            "display": "Housing status"
          } ],
          "text": "Housing status"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30189-7",
            "display": "I have housing"
          } ],
          "text": "I have housing"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "63512-8",
            "display": "How many people are living or staying at this address [#]"
          } ],
          "text": "How many people are living or staying at this address [#]"
        },
        "valueQuantity": {
          "value": 8,
          "unit": "{#}",
          "system": "http://unitsofmeasure.org",
          "code": "{#}"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "54899-0",
            "display": "Preferred language"
          } ],
          "text": "Preferred language"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA43-5",
            "display": "English"
          } ],
          "text": "English"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93034-7",
            "display": "Discharged from the U.S. Armed Forces"
          } ],
          "text": "Discharged from the U.S. Armed Forces"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "93035-4",
            "display": "Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]"
          } ],
          "text": "Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "32624-9",
            "display": "Race"
          } ],
          "text": "Race"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA4457-3",
            "display": "White"
          } ],
          "text": "White"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "56051-6",
            "display": "Hispanic or Latino"
          } ],
          "text": "Hispanic or Latino"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA32-8",
            "display": "No"
          } ],
          "text": "No"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-01ef-62002d017aa0",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-01ef-62002d017aa0",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "76504-0",
          "display": "Total score [HARK]"
        } ],
        "text": "Total score [HARK]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T04:36:17+00:00",
      "issued": "2025-06-21T04:36:17.663+00:00",
      "valueQuantity": {
        "value": 0,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6a8f-8beed35e3c1a",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-6a8f-8beed35e3c1a",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55758-7",
          "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
        } ],
        "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T05:12:30+00:00",
      "issued": "2025-06-21T05:12:30.663+00:00",
      "valueQuantity": {
        "value": 2,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0627-d10fbf0afe08",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-0627-d10fbf0afe08",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "75626-2",
          "display": "Total score [AUDIT-C]"
        } ],
        "text": "Total score [AUDIT-C]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T05:55:23+00:00",
      "issued": "2025-06-21T05:55:23.663+00:00",
      "valueQuantity": {
        "value": 3,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4d99-87df08b8e07e",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-4d99-87df08b8e07e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "710824005",
          "display": "Assessment of health and social care needs (procedure)"
        } ],
        "text": "Assessment of health and social care needs (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "performedPeriod": {
        "start": "2025-06-21T03:16:29+00:00",
        "end": "2025-06-21T04:08:31+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-fe71-21999d20b147",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-fe71-21999d20b147",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "866148006",
          "display": "Screening for domestic abuse (procedure)"
        } ],
        "text": "Screening for domestic abuse (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "performedPeriod": {
        "start": "2025-06-21T04:08:31+00:00",
        "end": "2025-06-21T04:36:17+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-60fe-af3532916e03",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-60fe-af3532916e03",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "performedPeriod": {
        "start": "2025-06-21T04:36:17+00:00",
        "end": "2025-06-21T04:50:06+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-561c-ef20f3e0cf88",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-561c-ef20f3e0cf88",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "performedPeriod": {
        "start": "2025-06-21T04:50:06+00:00",
        "end": "2025-06-21T05:12:30+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3711-d2284aa4707c",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-3711-d2284aa4707c",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "428211000124100",
          "display": "Assessment of substance use (procedure)"
        } ],
        "text": "Assessment of substance use (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "performedPeriod": {
        "start": "2025-06-21T05:12:30+00:00",
        "end": "2025-06-21T05:26:45+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-622e-d0b9332bafb1",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-622e-d0b9332bafb1",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "763302001",
          "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
        } ],
        "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "performedPeriod": {
        "start": "2025-06-21T05:26:45+00:00",
        "end": "2025-06-21T05:55:23+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-101b-59f78660c001",
    "resource": {
      "resourceType": "Immunization",
      "id": "a00b5c95-fed5-f472-101b-59f78660c001",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "140",
          "display": "Influenza, split virus, trivalent, PF"
        } ],
        "text": "Influenza, split virus, trivalent, PF"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "encounter": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "date": "2025-06-21T03:16:29+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-1bd8-188f65d6ffd5",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-1bd8-188f65d6ffd5",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "76499-3",
          "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
        } ],
        "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T04:36:17+00:00",
      "issued": "2025-06-21T04:36:17.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-01ef-62002d017aa0",
        "display": "Total score [HARK]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-fff3-46d8c709c3d9",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-fff3-46d8c709c3d9",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55757-9",
          "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
        } ],
        "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T05:12:30+00:00",
      "issued": "2025-06-21T05:12:30.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-6a8f-8beed35e3c1a",
        "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a0ce-ac7cbe74b004",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "a00b5c95-fed5-f472-a0ce-ac7cbe74b004",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "72109-2",
          "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
        } ],
        "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
      },
      "effectiveDateTime": "2025-06-21T05:55:23+00:00",
      "issued": "2025-06-21T05:55:23.663+00:00",
      "result": [ {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0627-d10fbf0afe08",
        "display": "Total score [AUDIT-C]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d49c-658b9b4d790e",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-d49c-658b9b4d790e",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-06-21T03:16:29+00:00",
        "end": "2025-06-21T04:08:31+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6f90eaad-abe3-3ce0-b9a6-2031c5674f0d",
        "display": "MYHOME HEALTHCARE PLLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-101b-59f78660c001"
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 3,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 4,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-1c43-5007131d3a94"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-7e4d-823c50dce279"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-4d99-87df08b8e07e"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-fe71-21999d20b147"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-60fe-af3532916e03"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-561c-ef20f3e0cf88"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-3711-d2284aa4707c"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-622e-d0b9332bafb1"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-4f6c-eca24c566518"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 4,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710824005"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "diagnosisLinkId": [ 2 ]
      }, {
        "sequence": 6,
        "procedureLinkId": [ 2 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "866148006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "procedureLinkId": [ 3 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 9,
        "procedureLinkId": [ 4 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 10,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 11,
        "procedureLinkId": [ 5 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "428211000124100"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 12,
        "procedureLinkId": [ 6 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "763302001"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 13,
        "informationLinkId": [ 4 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 3084.94,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:1330cbcb-b944-273f-83a7-7bc60bc4f012",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "1330cbcb-b944-273f-83a7-7bc60bc4f012",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-d49c-658b9b4d790e"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2025-06-21T04:08:31+00:00",
        "end": "2026-06-21T04:08:31+00:00"
      },
      "provider": {
        "identifier": {
          "value": "2e3b72c0-7af9-3c34-a705-d894aacce6ac"
        }
      },
      "organization": {
        "identifier": {
          "value": "6f90eaad-abe3-3ce0-b9a6-2031c5674f0d"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999943696"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "diagnosis": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-1c43-5007131d3a94"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
            "code": "Y",
            "display": "Diagnosis present at time of admission"
          }
        } ],
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-7e4d-823c50dce279"
        },
        "type": [ {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/codesystem/diagnosis-type",
            "code": "principal"
          } ]
        } ]
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.360000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 109.44000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.80,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 27.200000000000003,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 108.80000000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 136.00,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 3,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710824005"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 5,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 6,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "866148006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 7,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 8,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 9,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "171207006"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 10,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 11,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "428211000124100"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 12,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "763302001"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 13,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 14.916,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 59.664,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 74.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 704.20,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 2467.952,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-c067-d8e84dc9dc15",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "185347001",
          "display": "Encounter for problem (procedure)"
        } ],
        "text": "Encounter for problem (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2025-06-28T03:16:29+00:00",
        "end": "2025-06-28T03:46:31+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e8cc-76c1a5258afe",
    "resource": {
      "resourceType": "AllergyIntolerance",
      "id": "a00b5c95-fed5-f472-e8cc-76c1a5258afe",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "type": "allergy",
      "category": [ "food" ],
      "criticality": "low",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ],
        "text": "Allergic disposition (finding)"
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "assertedDate": "2025-06-28T03:16:29+00:00"
    },
    "request": {
      "method": "POST",
      "url": "AllergyIntolerance"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c121-7523c53a6d99",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-c121-7523c53a6d99",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6206-7",
          "display": "Peanut IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Peanut IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.049797,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-1726-f3303840213e",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-1726-f3303840213e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6273-7",
          "display": "Walnut IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Walnut IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.33622,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d433-f50063f2e10f",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-d433-f50063f2e10f",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6082-2",
          "display": "Codfish IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Codfish IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.033882,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e338-a45a4a53a2c2",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-e338-a45a4a53a2c2",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6246-3",
          "display": "Shrimp IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Shrimp IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.30622,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-bd34-a10d640bed78",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-bd34-a10d640bed78",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6276-0",
          "display": "Wheat IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Wheat IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.10514,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5d52-d04385fa988a",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-5d52-d04385fa988a",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6106-9",
          "display": "Egg white IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Egg white IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.0059444,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7722-4d1f40073288",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-7722-4d1f40073288",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6248-9",
          "display": "Soybean IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Soybean IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.11423,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5715-4e7f2d16547e",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-5715-4e7f2d16547e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "7258-7",
          "display": "Cow milk IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Cow milk IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.32597,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-eea8-1620d8d96579",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-eea8-1620d8d96579",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6189-5",
          "display": "White oak IgE Ab [Units/volume] in Serum"
        } ],
        "text": "White oak IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.076660,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-791f-3cee12d89249",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-791f-3cee12d89249",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6085-5",
          "display": "Common Ragweed IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Common Ragweed IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.16902,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-34ed-f08fd6bdfd87",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-34ed-f08fd6bdfd87",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6833-8",
          "display": "Cat dander IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Cat dander IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.21431,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-05c9-f647bcd56bd9",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-05c9-f647bcd56bd9",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6095-4",
          "display": "American house dust mite IgE Ab [Units/volume] in Serum"
        } ],
        "text": "American house dust mite IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.099128,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ad7c-86fe0b23f074",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-ad7c-86fe0b23f074",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6075-6",
          "display": "Cladosporium herbarum IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Cladosporium herbarum IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.11914,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-32dc-5898a3af5de2",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-32dc-5898a3af5de2",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6844-5",
          "display": "Honey bee IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Honey bee IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.29789,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-284e-688fd7c57f05",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-284e-688fd7c57f05",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6158-0",
          "display": "Latex IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Latex IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "effectiveDateTime": "2025-06-28T03:46:31+00:00",
      "issued": "2025-06-28T03:46:31.663+00:00",
      "valueQuantity": {
        "value": 0.23426,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0dc0-c49db6feb9f5",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-0dc0-c49db6feb9f5",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "395142003",
          "display": "Allergy screening test (procedure)"
        } ],
        "text": "Allergy screening test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "performedPeriod": {
        "start": "2025-06-28T03:16:29+00:00",
        "end": "2025-06-28T03:46:31+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c2f0-5bc0868f5c5b",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "a00b5c95-fed5-f472-c2f0-5bc0868f5c5b",
      "status": "active",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "997501",
          "display": "Fexofenadine hydrochloride 60 MG Oral Tablet"
        } ],
        "text": "Fexofenadine hydrochloride 60 MG Oral Tablet"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "authoredOn": "2025-06-28T03:46:31+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
          "display": "LAWRENCE GENERAL HOSPITAL"
        }
      },
      "dosageInstruction": [ {
        "sequence": 1,
        "asNeededBoolean": true
      } ]
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9e8e-235dd2fd351c",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-9e8e-235dd2fd351c",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-06-28T03:16:29+00:00",
        "end": "2025-06-28T03:46:31+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "prescription": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c2f0-5bc0868f5c5b"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
        } ]
      } ],
      "total": {
        "value": 214.03,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-2484-f7f338daf6ff",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "a00b5c95-fed5-f472-2484-f7f338daf6ff",
      "status": "active",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "1870230",
          "display": "NDA020800 0.3 ML Epinephrine 1 MG/ML Auto-Injector"
        } ],
        "text": "NDA020800 0.3 ML Epinephrine 1 MG/ML Auto-Injector"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "authoredOn": "2025-06-28T03:46:31+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
          "display": "LAWRENCE GENERAL HOSPITAL"
        }
      },
      "dosageInstruction": [ {
        "sequence": 1,
        "asNeededBoolean": true
      } ]
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d866-92eb0bc1e2e8",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-d866-92eb0bc1e2e8",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-06-28T03:16:29+00:00",
        "end": "2025-06-28T03:46:31+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "prescription": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-2484-f7f338daf6ff"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
        } ]
      } ],
      "total": {
        "value": 99.76,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-caac-cb711877b06b",
    "resource": {
      "resourceType": "CarePlan",
      "id": "a00b5c95-fed5-f472-caac-cb711877b06b",
      "status": "active",
      "intent": "order",
      "category": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "384758001",
          "display": "Self-care interventions (procedure)"
        } ],
        "text": "Self-care interventions (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
      },
      "period": {
        "start": "2025-06-28T03:46:31+00:00"
      },
      "activity": [ {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "58332002",
              "display": "Allergy education (procedure)"
            } ],
            "text": "Allergy education (procedure)"
          },
          "status": "in-progress"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "CarePlan"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-52ed-e60975070583",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-52ed-e60975070583",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-06-28T03:16:29+00:00",
        "end": "2025-06-28T03:46:31+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0dc0-c49db6feb9f5"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c067-d8e84dc9dc15"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "395142003"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 516.95,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:79236b58-ad3c-3b9f-a08e-6afdd549e93a",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "79236b58-ad3c-3b9f-a08e-6afdd549e93a",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-52ed-e60975070583"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2025-06-28T03:46:31+00:00",
        "end": "2026-06-28T03:46:31+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 17.11,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 68.44,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 85.55,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "395142003"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 516.95,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 413.56,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-61f6-5c380dda8dcc",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "170837001",
          "display": "Allergic disorder initial assessment (regime/therapy)"
        } ],
        "text": "Allergic disorder initial assessment (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2025-06-28T03:46:31+00:00",
        "end": "2025-06-28T04:09:06+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a34e-5836945fc239",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-a34e-5836945fc239",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6206-7",
          "display": "Peanut IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Peanut IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.025283,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-511b-7dba26a3cd2c",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-511b-7dba26a3cd2c",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6273-7",
          "display": "Walnut IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Walnut IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.10909,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-79ce-ec122bfc7ea9",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-79ce-ec122bfc7ea9",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6082-2",
          "display": "Codfish IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Codfish IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.16606,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-be3c-958c1b7cd30f",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-be3c-958c1b7cd30f",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6246-3",
          "display": "Shrimp IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Shrimp IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.27803,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-66ff-1a581c1c1592",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-66ff-1a581c1c1592",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6276-0",
          "display": "Wheat IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Wheat IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.20621,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6a0c-9c6929a2f04e",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-6a0c-9c6929a2f04e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6106-9",
          "display": "Egg white IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Egg white IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.014160,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6b6a-6d9f90d0e99f",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-6b6a-6d9f90d0e99f",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6248-9",
          "display": "Soybean IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Soybean IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.023750,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-20ea-fc27adcbe2af",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-20ea-fc27adcbe2af",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "7258-7",
          "display": "Cow milk IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Cow milk IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.087827,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-89b3-a1237ef06b50",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-89b3-a1237ef06b50",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6189-5",
          "display": "White oak IgE Ab [Units/volume] in Serum"
        } ],
        "text": "White oak IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.040892,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-05fe-3585a832ff0b",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-05fe-3585a832ff0b",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6085-5",
          "display": "Common Ragweed IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Common Ragweed IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.32998,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5464-913f8daf7f78",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-5464-913f8daf7f78",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6833-8",
          "display": "Cat dander IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Cat dander IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.072885,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-fe42-58a168057fcf",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-fe42-58a168057fcf",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6095-4",
          "display": "American house dust mite IgE Ab [Units/volume] in Serum"
        } ],
        "text": "American house dust mite IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.14856,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9e9b-bbf8a7f535bf",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-9e9b-bbf8a7f535bf",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6075-6",
          "display": "Cladosporium herbarum IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Cladosporium herbarum IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.25995,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-64be-0d7ec19a237e",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-64be-0d7ec19a237e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6844-5",
          "display": "Honey bee IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Honey bee IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.079136,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-17b9-5174f7ddcf20",
    "resource": {
      "resourceType": "Observation",
      "id": "a00b5c95-fed5-f472-17b9-5174f7ddcf20",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6158-0",
          "display": "Latex IgE Ab [Units/volume] in Serum"
        } ],
        "text": "Latex IgE Ab [Units/volume] in Serum"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "effectiveDateTime": "2025-06-28T04:09:06+00:00",
      "issued": "2025-06-28T04:09:06.663+00:00",
      "valueQuantity": {
        "value": 0.077555,
        "unit": "kU/L",
        "system": "http://unitsofmeasure.org",
        "code": "kU/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0a41-95885ff6e29b",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-0a41-95885ff6e29b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "395142003",
          "display": "Allergy screening test (procedure)"
        } ],
        "text": "Allergy screening test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "performedPeriod": {
        "start": "2025-06-28T03:46:31+00:00",
        "end": "2025-06-28T04:09:06+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-cc34-a4559ad674ea",
    "resource": {
      "resourceType": "CarePlan",
      "id": "a00b5c95-fed5-f472-cc34-a4559ad674ea",
      "status": "active",
      "intent": "order",
      "category": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "170836005",
          "display": "Allergic disorder monitoring (regime/therapy)"
        } ],
        "text": "Allergic disorder monitoring (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
      },
      "period": {
        "start": "2025-06-28T03:46:31+00:00"
      },
      "activity": [ {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "182678001",
              "display": "Allergen immunotherapy (regime/therapy)"
            } ],
            "text": "Allergen immunotherapy (regime/therapy)"
          },
          "status": "in-progress"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "CarePlan"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-31e3-a60cd7330346",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-31e3-a60cd7330346",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-06-28T03:46:31+00:00",
        "end": "2025-06-28T04:09:06+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0a41-95885ff6e29b"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-61f6-5c380dda8dcc"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "395142003"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 573.98,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:ed5dc15c-5f35-c8ba-4a4c-01225e8018d6",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "ed5dc15c-5f35-c8ba-4a4c-01225e8018d6",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-31e3-a60cd7330346"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2025-06-28T04:09:06+00:00",
        "end": "2026-06-28T04:09:06+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "395142003"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 86.28,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 345.12,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 431.40,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 573.98,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 459.184,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b063-71c935b957b3",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-b063-71c935b957b3",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2025-07-25T04:09:06+00:00",
        "end": "2025-07-25T05:04:10+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ce2e-71f2f6dfd995",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-ce2e-71f2f6dfd995",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-b063-71c935b957b3"
      },
      "performedPeriod": {
        "start": "2025-07-25T04:09:06+00:00",
        "end": "2025-07-25T05:04:10+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-6259-56e28ddb34d8",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-6259-56e28ddb34d8",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-07-25T04:09:06+00:00",
        "end": "2025-07-25T05:04:10+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-ce2e-71f2f6dfd995"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-b063-71c935b957b3"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 9452.41,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 9594.99,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:f3801869-cb6f-d629-3b9e-0108776e6aca",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "f3801869-cb6f-d629-3b9e-0108776e6aca",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-6259-56e28ddb34d8"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2025-07-25T05:04:10+00:00",
        "end": "2026-07-25T05:04:10+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 1890.482,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 7561.928,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 9452.41,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 9452.41,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 9594.99,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 7675.992,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-26ff-9c6b982c172c",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-26ff-9c6b982c172c",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2025-08-16T05:04:10+00:00",
        "end": "2025-08-16T05:49:20+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d071-79bc1f497f77",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-d071-79bc1f497f77",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-26ff-9c6b982c172c"
      },
      "performedPeriod": {
        "start": "2025-08-16T05:04:10+00:00",
        "end": "2025-08-16T05:49:20+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9757-c47a67e84947",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-9757-c47a67e84947",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-08-16T05:04:10+00:00",
        "end": "2025-08-16T05:49:20+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-d071-79bc1f497f77"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-26ff-9c6b982c172c"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 5121.09,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 5263.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:96f60dd0-639c-9c41-9148-8f299a6836f1",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "96f60dd0-639c-9c41-9148-8f299a6836f1",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-9757-c47a67e84947"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2025-08-16T05:49:20+00:00",
        "end": "2026-08-16T05:49:20+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 1024.218,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 4096.872,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 5121.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 5121.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 5263.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 4210.936000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0789-83ecf62de23d",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-0789-83ecf62de23d",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2025-09-06T05:49:20+00:00",
        "end": "2025-09-06T06:25:46+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4f49-d506e3e149ac",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-4f49-d506e3e149ac",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-0789-83ecf62de23d"
      },
      "performedPeriod": {
        "start": "2025-09-06T05:49:20+00:00",
        "end": "2025-09-06T06:25:46+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-28c8-1dc3b2b03514",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-28c8-1dc3b2b03514",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-09-06T05:49:20+00:00",
        "end": "2025-09-06T06:25:46+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-4f49-d506e3e149ac"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0789-83ecf62de23d"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 5814.25,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 5956.83,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:ef21330c-63c6-0b39-0817-16f58ec5b062",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "ef21330c-63c6-0b39-0817-16f58ec5b062",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-28c8-1dc3b2b03514"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2025-09-06T06:25:46+00:00",
        "end": "2026-09-06T06:25:46+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 1162.8500000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 4651.400000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 5814.25,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 5814.25,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 5956.83,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 4765.464000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-fe6b-0121a55ac1c1",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-fe6b-0121a55ac1c1",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2025-10-03T06:25:46+00:00",
        "end": "2025-10-03T07:23:57+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-11f0-168dcec0811d",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-11f0-168dcec0811d",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-fe6b-0121a55ac1c1"
      },
      "performedPeriod": {
        "start": "2025-10-03T06:25:46+00:00",
        "end": "2025-10-03T07:23:57+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-a8a7-962826898d74",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-a8a7-962826898d74",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-10-03T06:25:46+00:00",
        "end": "2025-10-03T07:23:57+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-11f0-168dcec0811d"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-fe6b-0121a55ac1c1"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 16557.13,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 16699.71,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:9a5ccb2d-7a1c-fb4d-5da2-ca77ca5799e6",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "9a5ccb2d-7a1c-fb4d-5da2-ca77ca5799e6",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-a8a7-962826898d74"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2025-10-03T07:23:57+00:00",
        "end": "2026-10-03T07:23:57+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 3311.4260000000004,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 13245.704000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 16557.13,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 16557.13,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 16699.71,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 13359.768000000002,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-d937-ff7d51a98190",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-d937-ff7d51a98190",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2025-10-24T07:23:57+00:00",
        "end": "2025-10-24T08:16:11+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9978-df9e5fea5a91",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-9978-df9e5fea5a91",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-d937-ff7d51a98190"
      },
      "performedPeriod": {
        "start": "2025-10-24T07:23:57+00:00",
        "end": "2025-10-24T08:16:11+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-4c12-afbfae6d9091",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-4c12-afbfae6d9091",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-10-24T07:23:57+00:00",
        "end": "2025-10-24T08:16:11+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-9978-df9e5fea5a91"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-d937-ff7d51a98190"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 14553.71,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 14696.29,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:933d6fdd-9b3b-3e6c-a4b1-215d6dcf4ec5",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "933d6fdd-9b3b-3e6c-a4b1-215d6dcf4ec5",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-4c12-afbfae6d9091"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2025-10-24T08:16:11+00:00",
        "end": "2026-10-24T08:16:11+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 2910.742,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 11642.968,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 14553.71,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 14553.71,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 14696.29,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 11757.032000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8878-929216da8f9d",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-8878-929216da8f9d",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2025-11-19T08:16:11+00:00",
        "end": "2025-11-19T09:05:43+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-681e-04f2cb00207e",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-681e-04f2cb00207e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8878-929216da8f9d"
      },
      "performedPeriod": {
        "start": "2025-11-19T08:16:11+00:00",
        "end": "2025-11-19T09:05:43+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c0fa-12e02c797ece",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-c0fa-12e02c797ece",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-11-19T08:16:11+00:00",
        "end": "2025-11-19T09:05:43+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-681e-04f2cb00207e"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-8878-929216da8f9d"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 5121.09,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 5263.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:f44771f5-c2fb-2387-82f7-6c484549504b",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "f44771f5-c2fb-2387-82f7-6c484549504b",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-c0fa-12e02c797ece"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2025-11-19T09:05:43+00:00",
        "end": "2026-11-19T09:05:43+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 1024.218,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 4096.872,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 5121.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 5121.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 5263.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 4210.936000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-789f-7cd29e4afe5a",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-789f-7cd29e4afe5a",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2025-12-14T09:05:43+00:00",
        "end": "2025-12-14T09:48:33+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0f23-7c8df54ef889",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-0f23-7c8df54ef889",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-789f-7cd29e4afe5a"
      },
      "performedPeriod": {
        "start": "2025-12-14T09:05:43+00:00",
        "end": "2025-12-14T09:48:33+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-df21-88ac77bb6a8c",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-df21-88ac77bb6a8c",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2025-12-14T09:05:43+00:00",
        "end": "2025-12-14T09:48:33+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0f23-7c8df54ef889"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-789f-7cd29e4afe5a"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 15380.89,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 15523.47,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:477216f4-5bda-dc41-41c4-9982fec91af1",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "477216f4-5bda-dc41-41c4-9982fec91af1",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-df21-88ac77bb6a8c"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2025-12-14T09:48:33+00:00",
        "end": "2026-12-14T09:48:33+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 3076.178,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 12304.712,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 15380.89,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 15380.89,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 15523.47,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 12418.776,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-eae5-b15eaceb7769",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-eae5-b15eaceb7769",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2026-01-06T09:48:33+00:00",
        "end": "2026-01-06T10:15:11+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b4f8-cd0e5d78d451",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-b4f8-cd0e5d78d451",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-eae5-b15eaceb7769"
      },
      "performedPeriod": {
        "start": "2026-01-06T09:48:33+00:00",
        "end": "2026-01-06T10:15:11+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3393-b98aaeddc997",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-3393-b98aaeddc997",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2026-01-06T09:48:33+00:00",
        "end": "2026-01-06T10:15:11+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-b4f8-cd0e5d78d451"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-eae5-b15eaceb7769"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 5413.09,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 5555.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:ea877822-061f-c40b-13c8-dd19dc031c09",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "ea877822-061f-c40b-13c8-dd19dc031c09",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-3393-b98aaeddc997"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2026-01-06T10:15:11+00:00",
        "end": "2027-01-06T10:15:11+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 1082.6180000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 4330.472000000001,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 5413.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 5413.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 5555.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 4444.536000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e2a8-5ed21c3868ab",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-e2a8-5ed21c3868ab",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2026-02-02T10:15:11+00:00",
        "end": "2026-02-02T10:39:05+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0ae3-c3166943f5ec",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-0ae3-c3166943f5ec",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-e2a8-5ed21c3868ab"
      },
      "performedPeriod": {
        "start": "2026-02-02T10:15:11+00:00",
        "end": "2026-02-02T10:39:05+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-632b-e6c66ba4ff66",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-632b-e6c66ba4ff66",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2026-02-02T10:15:11+00:00",
        "end": "2026-02-02T10:39:05+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0ae3-c3166943f5ec"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-e2a8-5ed21c3868ab"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 10782.20,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 10924.78,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:ecd5c08d-4d76-8e00-e9ff-02150e51fd58",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "ecd5c08d-4d76-8e00-e9ff-02150e51fd58",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-632b-e6c66ba4ff66"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2026-02-02T10:39:05+00:00",
        "end": "2027-02-02T10:39:05+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 2156.44,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 8625.76,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 10782.20,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 10782.20,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 10924.78,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 8739.824,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5120-7b60beb92fe2",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-5120-7b60beb92fe2",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2026-03-01T10:39:05+00:00",
        "end": "2026-03-01T11:06:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-74f7-477b5ef7b4f7",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-74f7-477b5ef7b4f7",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-5120-7b60beb92fe2"
      },
      "performedPeriod": {
        "start": "2026-03-01T10:39:05+00:00",
        "end": "2026-03-01T11:06:30+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-b8a3-cddffac41b3b",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-b8a3-cddffac41b3b",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2026-03-01T10:39:05+00:00",
        "end": "2026-03-01T11:06:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-74f7-477b5ef7b4f7"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-5120-7b60beb92fe2"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 15544.51,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 15687.09,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:d4c68055-891e-a451-7b76-7aa80c73b6d3",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "d4c68055-891e-a451-7b76-7aa80c73b6d3",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-b8a3-cddffac41b3b"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2026-03-01T11:06:30+00:00",
        "end": "2027-03-01T11:06:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 3108.902,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 12435.608,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 15544.51,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 15544.51,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 15687.09,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 12549.672,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c325-5477892afbf2",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-c325-5477892afbf2",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2026-03-23T11:06:30+00:00",
        "end": "2026-03-23T11:33:45+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-589d-63eea8b7871b",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-589d-63eea8b7871b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c325-5477892afbf2"
      },
      "performedPeriod": {
        "start": "2026-03-23T11:06:30+00:00",
        "end": "2026-03-23T11:33:45+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-e682-a2f21c0d23f3",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-e682-a2f21c0d23f3",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2026-03-23T11:06:30+00:00",
        "end": "2026-03-23T11:33:45+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-589d-63eea8b7871b"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c325-5477892afbf2"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 17790.09,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 17932.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:87182283-1202-fce2-c8df-0504575afa0b",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "87182283-1202-fce2-c8df-0504575afa0b",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-e682-a2f21c0d23f3"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2026-03-23T11:33:45+00:00",
        "end": "2027-03-23T11:33:45+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 3558.018,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 14232.072,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 17790.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 17790.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 17932.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 14346.136,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-bc7a-18f0d8c18ad8",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-bc7a-18f0d8c18ad8",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2026-04-17T11:33:45+00:00",
        "end": "2026-04-17T12:22:41+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-3c0e-bd5460d339d1",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-3c0e-bd5460d339d1",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-bc7a-18f0d8c18ad8"
      },
      "performedPeriod": {
        "start": "2026-04-17T11:33:45+00:00",
        "end": "2026-04-17T12:22:41+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-5162-d80bab8ec0d1",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-5162-d80bab8ec0d1",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2026-04-17T11:33:45+00:00",
        "end": "2026-04-17T12:22:41+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-3c0e-bd5460d339d1"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-bc7a-18f0d8c18ad8"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 20484.38,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 20626.96,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:fc545814-8167-0e00-f97d-99fb99e40158",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "fc545814-8167-0e00-f97d-99fb99e40158",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-5162-d80bab8ec0d1"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2026-04-17T12:22:41+00:00",
        "end": "2027-04-17T12:22:41+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 4096.876,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 16387.504,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 20484.38,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 20484.38,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 20626.96,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 16501.568,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9ccd-52041602f0b6",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-9ccd-52041602f0b6",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2026-05-10T12:22:41+00:00",
        "end": "2026-05-10T12:58:31+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-0649-9b142c5fc886",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-0649-9b142c5fc886",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-9ccd-52041602f0b6"
      },
      "performedPeriod": {
        "start": "2026-05-10T12:22:41+00:00",
        "end": "2026-05-10T12:58:31+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-9d0d-7eb8cdf8861a",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-9d0d-7eb8cdf8861a",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2026-05-10T12:22:41+00:00",
        "end": "2026-05-10T12:58:31+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-0649-9b142c5fc886"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-9ccd-52041602f0b6"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 5121.09,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 5263.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:76106021-c202-552c-b815-2062e55a5255",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "76106021-c202-552c-b815-2062e55a5255",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-9d0d-7eb8cdf8861a"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2026-05-10T12:58:31+00:00",
        "end": "2027-05-10T12:58:31+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 1024.218,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 4096.872,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 5121.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 5121.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 5263.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 4210.936000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-c5ca-158eea026a53",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-c5ca-158eea026a53",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2026-06-04T12:58:31+00:00",
        "end": "2026-06-04T13:24:23+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-7d17-6f41e9a6a21b",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-7d17-6f41e9a6a21b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-c5ca-158eea026a53"
      },
      "performedPeriod": {
        "start": "2026-06-04T12:58:31+00:00",
        "end": "2026-06-04T13:24:23+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-724b-cd7ae578b8bb",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-724b-cd7ae578b8bb",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2026-06-04T12:58:31+00:00",
        "end": "2026-06-04T13:24:23+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-7d17-6f41e9a6a21b"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-c5ca-158eea026a53"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 5121.09,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 5263.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:d6800661-88e6-03c8-d13f-efab9a0dc566",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "d6800661-88e6-03c8-d13f-efab9a0dc566",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-724b-cd7ae578b8bb"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2026-06-04T13:24:23+00:00",
        "end": "2027-06-04T13:24:23+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 1024.218,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 4096.872,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 5121.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 5121.09,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 5263.67,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 4210.936000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-8769-de90fa5087ce",
    "resource": {
      "resourceType": "Encounter",
      "id": "a00b5c95-fed5-f472-8769-de90fa5087ce",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "371883000",
          "display": "Outpatient procedure (procedure)"
        } ],
        "text": "Outpatient procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999995191",
          "display": "Dr. Carisa395 Kutch271"
        }
      } ],
      "period": {
        "start": "2026-06-26T13:24:23+00:00",
        "end": "2026-06-26T13:48:09+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-39ed-30f416b1f5fb",
    "resource": {
      "resourceType": "Procedure",
      "id": "a00b5c95-fed5-f472-39ed-30f416b1f5fb",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "180256009",
          "display": "Subcutaneous immunotherapy (procedure)"
        } ],
        "text": "Subcutaneous immunotherapy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "context": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-8769-de90fa5087ce"
      },
      "performedPeriod": {
        "start": "2026-06-26T13:24:23+00:00",
        "end": "2026-06-26T13:48:09+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:a00b5c95-fed5-f472-ec67-f3328efc291f",
    "resource": {
      "resourceType": "Claim",
      "id": "a00b5c95-fed5-f472-ec67-f3328efc291f",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "start": "2026-06-26T13:24:23+00:00",
        "end": "2026-06-26T13:48:09+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|53f086de-2fc7-3d35-92c2-aca4ed944e7f",
        "display": "LAWRENCE GENERAL HOSPITAL"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:a00b5c95-fed5-f472-39ed-30f416b1f5fb"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:a00b5c95-fed5-f472-8769-de90fa5087ce"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "net": {
          "value": 20484.38,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 20626.96,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:06d8d363-549f-3bab-067d-fbab7ec26796",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "06d8d363-549f-3bab-067d-fbab7ec26796",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Blue Cross Blue Shield"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-profnl-cmpnt-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-ptb-coinsrnc-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-prvdr-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-op-bene-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-nch-bene-blood-ddctbl-lblty-am-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension",
        "valueCoding": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd",
          "code": "N",
          "display": "All other reasons for non-payment"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-fi-num-extension",
        "valueIdentifier": {
          "system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-fi-num",
          "value": "002000"
        }
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "a00b5c95-fed5-f472-ec67-f3328efc291f"
      }, {
        "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
        "value": "99999999999"
      } ],
      "status": "active",
      "type": {
        "coding": [ {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
          "code": "71",
          "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
        }, {
          "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
          "code": "CARRIER",
          "display": "EOB Type"
        }, {
          "system": "http://hl7.org/fhir/ex-claimtype",
          "code": "professional",
          "display": "Claim Type"
        }, {
          "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
          "code": "O",
          "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
        } ]
      },
      "patient": {
        "reference": "urn:uuid:a00b5c95-fed5-f472-749b-6b3140ead250"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2026-06-26T13:48:09+00:00",
        "end": "2027-06-26T13:48:09+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d3e58c21-4611-3588-9fe2-7a9a181aa2c0"
        }
      },
      "organization": {
        "identifier": {
          "value": "53f086de-2fc7-3d35-92c2-aca4ed944e7f"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999995191"
          }
        },
        "role": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claimcareteamrole",
            "code": "primary",
            "display": "Primary provider"
          } ]
        }
      } ],
      "insurance": {
        "coverage": {
          "reference": "#coverage"
        }
      },
      "item": [ {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 1,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 28.516000000000005,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 114.06400000000002,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 142.58,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "extension": [ {
            "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ide-ndc-upc-num-extension",
            "valueCoding": {
              "system": "https://www.accessdata.fda.gov/scripts/cder/ndc",
              "code": "0624",
              "display": "Dummy"
            }
          } ],
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "180256009"
          } ]
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "adjudication": [ {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
              "display": "Line Beneficiary Coinsurance Amount"
            } ]
          },
          "amount": {
            "value": 4096.876,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 16387.504,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
              "display": "Line Submitted Charge Amount"
            } ]
          },
          "amount": {
            "value": 20484.38,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 20484.38,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
              "display": "Line Beneficiary Part B Deductible Amount"
            } ]
          },
          "amount": {
            "value": 0,
            "system": "urn:iso:std:iso:4217",
            "code": "USD"
          }
        }, {
          "category": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
              "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "display": "Line Processing Indicator Code"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 20626.96,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 16501.568,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  } ]
}
